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Main Pathological Pictures with Ultrasound

  • Giovanni MalferrariEmail author
  • Marialuisa Zedde
  • Patrizio Prati
Chapter

Abstract

The jugular vein valve system is located near the confluence of the IJV into the BCV. Its function is to prevent the retrograde flow toward the brain in case of sudden increase in intrathoracic pressure that may cause a transvalvular gradient up to 100 mmHg [1].

Keywords

Valve Incontinence Reflux Thrombosis Leaflet 

Supplementary material

309187_1_En_4_MOESM1_ESM.avi (479 kb)
Movie 4.1: Longitudinal B-mode scan. Opening and closing cycle of the jugular and vertebral system in a longitudinal scan with magnified image and clearly identifiable valve leaflets and their juxtaposition. Note the different length of the jugular valve leaflets with the relative hypomobility of the posterior leaflet (AVI 479 kb)

Movie 4.2: Longitudinal B-mode scan of IJV at the valve level. During the Valsalva maneuver a complete closure of the valve leaflets, despite their different length, can be noted (AVI 1968 kb)

Movie 4.3: IJV longitudinal Color-mode scan on the valve plane (same subject of Fig. 4.1 and 4.2 and of Movie 4.1 and 4.2). The hypomobility of the posterior leaflet is confirmed. During normal breathing, this causes a preferential laminar flow which runs along the outline of the posterior leaflet. During the Valsalva maneuver the complete closure of the valve leaflets and the absence of valve incontinence is confirmed (AVI 3019 kb)

Movie 4.4: IJV B-mode longitudinal scan with lateral approach. The movie clearly shows the relative redundancy of the valve leaflets, which however are fully mobile during the breath cycle (AVI 2162 kb)

Movie 4.5: IJV B-mode longitudinal scan with anterior approach on the same subject of Movie 4.4. There is the confirmation of the relative redundancy of the valve leaflets, which appear to overlap to a great extent. This however does not cause a real obstacle to the flow, neither can it imply a hemodynamically significant malformation. In fact, by associating the two insonation approaches, i.e. the lateral and the anterior one, it clearly comes across that there is only a slight redundancy of the valve leaflets as a morphologic non-specific marker (AVI 2679 kb)

Movie 4.6: J1 IJV Color-mode longitudinal scan with anterior approach on the same subject of figure 4.5. The absence of obstacles to the flow at the level of IJV valve system is confirmed as well as the relative hypomobility of the valve leaflets (AVI 891 kb)

Movie 4.7: J1 IJV transverse scan at the valve plane level (same subject of figures 4.5 and 4.6). The dynamic scan corroborates the redundancy of the valve leaflets, which are however mobile (AVI 1612 kb)

Movie 4.8: Longitudinal scan of the subclavean fossa on the conjunction of the IJV-SV-BCV. The sequence of events described in the caption of figure 4.10 can clearly be identified in the dynamic footage (AVI 1689 kb)

Movie 4.9: B-mode longitudinal scan on the IJV valve system. Note the extremely marked hypomobility of the two highlighted leaflets, which protrude into the lumen in an almost fixed way. The remaining mobility of the distal segments is minimal, thus determining a central channel of exceedingly small dimensions, which is always open during the breath and the cardiac cycle (AVI 3012 kb)

Movie 4.10: Color mode longitudinal scan of J1 IJV. Note that, with PRF of 2.0 KHz, a significant flow signal inside the IJV lumen cannot be detected (AVI 3401 kb)

Movie 4.11: B-mode longitudinal scan of J1 IJV. With a Valsalva maneuver a closing of the valve leaflets is obtained through the connection of the mobile distal part (AVI 3487 kb)

Movie 4.12: B-mode longitudinal scan of J2 IJV (same subject of Figures 4.11-4.14). At the level of the J2 segment of IJV a marked spontaneous echo-contrast can be seen. It is consistent with the slowing down of the flow caused by the valve system malformation (AVI 1573 kb)

Movie 4.13: Color-mode longitudinal scan of J2 IJV (same subject of Figures 4.11-4.14). In Color-mode it is confirmed the slowing down of the flow corresponding to the spontaneous echo-contrast, which was already clearly seen in B-mode (AVI 1696 kb)

Movie 4.14: Color-mode transverse scan of J2 IJV at the junction of the thyroid branch. It can be noted how the flow changes direction during the respiratory cycle, towards the IJV during the inspiratory phase, tending to invert incompletely during the expiratory phase and the straining phase of the Valsalva maneuver (AVI 2960 kb)

Movie 4.15: B-mode J1 IJV, longitudinal scan. It is possible to observe the uniform reduction of the caliber in the pre-valve IJV segment. The dynamics respiratory variations are slight (AVI 1793 kb)

Movie 4.16: B-mode, J2 IJV longitudinal scan (same subject of figure 4.19 and of movie 4.15). The flow velocity and direction, shown by the Color-mode and observed upstream from the caliber reduction, highlight a directional shift during the different phases of the respiratory and the cardiac cycle (AVI 1459 kb)

Movie 4.17: B-mode J2 IJV, transverse scan. Special attention is to be paid to the extreme caliber variability of IJV during the phases of the breath cycle (AVI 1740 kb)

Movie 4.18: Color-mode, transverse scan of J2 IJV. In particular, note the flow direction variation, parallel to the size changes during the phases of the respiratory cycle. The flow is orthograde in the inspiratory phase and inverted during the expiratory phase (AVI 3878 kb)

Movie 4.19: Color-mode, longitudinal scan of J1-2 IJV. Also in the dynamic scan (same subject of Figure 4.23) it can be noted how IJV looks basically empty and devoid of flow signal inside the lumen, whereas the common carotid artery shows a regular color-coded filling (AVI 2365 kb)

Movie 4.20: Color-mode, transverse scan of J2 IJV (same subject of figures 4.23 and 4.24). A transverse scan has been performed, with a compression by means of the probe, so as to show the absence of thrombotic endoluminal processes of the IJV (AVI 1786 kb)

Movie 4.21: B-mode, transverse scan of J2 IJV (same subject of Figures 4.23-4.25). Compared to the previous images, the presence of spontaneous echo-contrast, correlated effect of the extreme slowing of the flow at the IJV level, stands out (AVI 2642 kb)

Movies 4.22: Color-mode, J2 IJV transverse scan with decreasing PRF (1.5–1–0.5 KHz) (same subject of Figures 4.23-4.26).The initial appearance of a colorimetric spot caused by extremely low speed monophasic flow can be seen almost only in Movie 4.24, with PRF 0.5 KHz (AVI 7278 kb)

Movies 4.23: Color-mode, J2 IJV transverse scan with decreasing PRF (1.5–1–0.5 KHz) (same subject of Figures 4.23-4.26).The initial appearance of a colorimetric spot caused by extremely low speed monophasic flow can be seen almost only in Movie 4.24, with PRF 0.5 KHz (AVI 1197 kb)

Movies 4.24: Color-mode, J2 IJV transverse scan with decreasing PRF (1.5–1–0.5 KHz) (same subject of Figures 4.23-4.26).The initial appearance of a colorimetric spot caused by extremely low speed monophasic flow can be seen almost only in Movie 4.24, with PRF 0.5 KHz (AVI 1675 kb)

Movie 4.25: Color-mode, J2 IJV transverse scan (same subject of Figures 4.22-4.27). By means of the Valsalva maneuver a phasic transient colorimetric filling of the IJV lumen can be obtained. This represents further evidence of the absence of thrombotic events (AVI 2591 kb)

Movie 4.26: Color-mode, J3 IJV longitudinal scan (same subject of Figures 4.22-4.28). A colorimetric codification with alternating flow direction according to the respiratory cycle, can be observed upstream from the segments which have basically no endoluminal flow, as described in Figure 4.28 (AVI 2036 kb)

Movie 4.27: Color-mode, J3 IJV transverse scan (same subject of Figures 4.22-4.28). The situation is similar as the one shown in figure 4.28 and in movie 4.26 but in a transverse scan (AVI 1568 kb)

Movie 4.28: Color-mode, J1 IJV transverse scan at 90° (same subject of Figures 4.22-4.29). Also in the upright position the same findings of the former figures in supine position are confirmed. They relate to the absence of colorimetric flow signal identifiable on the J1 IJV (AVI 1765 kb)

Movie 4.29: Color-mode, J2 IJV transverse scan in upright position (same subject of figures 4.22-4.30). J2 lumen is almost empty and so difficult to identify. The flow is transiently induced through a deep inspirational maneuver, as shown in the movie (AVI 2723 kb)

Movie 4.30: B-mode, J1 IJV longitudinal scan. Note the clear spontaneous echo-contrast, mobile, at the level of the valve sinus of the posterior leaflet of the IJV valve system, with a slight hypomobility of the same leaflet (AVI 1583 kb)

Movie 4.31: B-mode, J1 IJV longitudinal scan with Valsalva maneuver. During the straining phase of Valsalva maneuver the spontaneous echo-contrast progressively disappears, in a parallel manner to the increase of the pressure, which diminishes the flow at the IJV level until it becomes zero (AVI 5390 kb)

Movie 4.32: J1, IJV transverse scan with magnified image. As in the previous figures, it can be clearly observed the spontaneous echo-contrast, on bicuspid valve, confined to the valve sinus corresponding to the posterior leaflet (AVI 1230 kb)

Movie 4.33: Color-mode, J1 IJV longitudinal scan (same subject of figures 4.31-4.34). Note the hypomobility of the posterior leaflet of the IJV valve system, with persistence of the spontaneous echo-contrast on the corresponding valve sinus and normal hemodynamic behavior in normal breathing conditions (AVI 2294 kb)

Movie 4.34: Color-mode, J1 IJV longitudinal scan (same subject of Figures 4.31-4.35). Note the hypomobility of the posterior leaflet of the IJV valve system, with persisting spontaneous echo-contrast on the corresponding valve sinus. The hemodynamics is normal in spontaneous breathing conditions, whereas during the Valsalva maneuver there is the presence of an eccentric reflux jet, which proceeds within the IJV lumen (AVI 1445 kb)

Movie 4.35: Color-mode, J1 IJV longitudinal scan (same subject as figures 4.31-4.37). A brief reflux jet stands out very clearly in the anterior scan rather than in the posterior one. It was already present in normal breathing conditions and it increases in volume and becomes of significant duration with the Valsalva maneuver (AVI 5080 kb)

Movie 4.36: Color-mode, J1 IJV longitudinal scan. Note how the area characterized by echo-contrast, caused by the slowing of the blood flow, is never actually reached by the color-coded signal (AVI 2408 kb)

Movie 4.37: B-mode, J1 IJV longitudinal scan. As pointed out in the caption to figure 4.39, the same findings clearly came across both in the still image and in the dynamic sequence, i.e. the exceedingly marked slowing of the blood flow at level of the J1 IJV. The echo-contrast has fine elements, is arranged in a column and shows a to and fro movement starting from the valve plane. It signals a stasis caused by an obstacle immediately downstream (AVI 500 kb)

Movie 4.38: Color-mode, J1 IJV longitudinal scan (same subject of figures 4.39-4.40 and of movie 4.37). The finding is basically the same as the one identified in movie 4.37, with the Color-code confirmation of the marked slowing down of the blood flow in the pre-valvular area (AVI 628 kb)

Movie 4.39: Color-mode, J1 IJV transverse scan (same subject of figures 4.39-4.40). By pressing on the vein with the probe, the absence of IJV endoluminal thrombosis is proved (AVI 5542 kb)

Movie 4.40: Color-code, J1 IJV longitudinal scan (same subject of Figures 4.39-4.41). By using PRF 2.0 KHz, the finding of extreme slowing down of flow velocity at pre-valvular level is confirmed (AVI 515 kb)

Movie 4.41: Color-code, J1 IJV longitudinal scan (same subject of figures 4.39-4.41). Also by using PRF 0.75 KHz, the finding of extreme slowing down of flow speed at pre-valvular level is confirmed (AVI 915 kb)

Movie 4.42: Color-mode, J2 IJV transverse scan. By performing the compression maneuver on the venous lumen with the probe, the lack of IJV compressibility, without flow and with the lumen occupied by hyperechoic thrombotic material, becomes evident (AVI 661 kb)

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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Giovanni Malferrari
    • 1
    Email author
  • Marialuisa Zedde
    • 1
  • Patrizio Prati
    • 2
  1. 1.Stroke Unit, Neurology Unit, Dept. of Neuromotor PhysiologyArcispedale Santa Maria Nuova IRCCSReggio EmiliaItaly
  2. 2.CIDIMUTorinoItaly

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