The sizes of internal jugular veins in Turkish children aged between 7 and 12 years

Abstract

Objective: In this study, we aimed at searching for internal jugular vein (IJV) diameters in Turkish children in order to learn about anatomic details of IJV diameters and to supplement the diagnostic criteria in vascular pathologies such as phlebectasia. Methods: A total of 92 children within the age range of 7–12 years were included in this study. In order to provide a consistent anatomical landmark in all subjects, all of the children were imaged by ultrasonography (USG) at the level of the cricoid cartilage. The measurements consisted the maximal antero-posterior (AP) and transverse (T) cross-sectional internal diameters of the internal jugular veins during both regular breathing and Valsalva maneuver. For the statistical purposes, the following analyses were performed: the relationship between the IJV diameters obtained at rest and those obtained during Valsalva maneuver, with the paired t-test; the relationship between the age groups and the IJV diameters, with the unpaired test. The significance was set at P<0.05. Results: During regular breathing, the mean transvers diameters of the right and left IJVs were 11.26 and 10.01 mm, respectively, while they were 16.28 and 13.61 mm during straining phase of the Valsalva maneuver. The mean antero-posterior diameters of the right and left IJVs before and during Valsalva maneuver were 7.64 and 6.8 mm versus 11.53 and 9.84 mm. The IJV diameters were larger on the right side than those on the left and also there were significant increases in the diameters by Valsalva maneuver. Conclusion: As a result, in this study performed among Turkish children aged between 7–12 years, it was shown that there was no correlation between the IJV diameters and the age groups (P>0.05), while there was a significant increase in the IJV diameters on Valsalva maneuver (P<0.05). We think that the results we obtained in this study may be useful and important for comparison in the patients with phlebectasia and also for the required knowledge of the anatomic details in medical interventions performed through IJV. However, since children aged between 0 and 6 years were not included in this study and the lack of relation found in our study may not be the same among 0–6 years, a further study is needed to show any interrelationship between former age group and size.

Introduction

Knowledge about the anatomical details of the internal jugular vein (IJV) sizes may be important for both utilization of procedures in medical practice and also in the diagnosis of pathologic situations like phlebectasia. IJV cannulation provides a rapid access to the central veins. Currently, intravascular interventional procedures via IJV are frequently performed. IJV may have variable sizes in adults [1]. Small size of the IJV may contribute to difficulty in cannulation with an increased chance of failure or complication [2]. Also, phlebectasia, a rarely encountered pathology of cervical region in children, may be defined as an abnormal dilatation of the IJV [3], [4]. There may be diagnostic problems in pediatric patients who present with phlebectasia mimicking other neck masses [5], [6]. In the literature, there are many studies about the sizes and cross-sectional area of the IJV, aiming at guiding both the interventional medical procedures and also the diagnosis of vascular pathologies like phlebectesia [1], [2], [7], [8], [9], [10]. Mortensen et al. [1] measured the cross-sectional internal diameters of IJVs in a study they performed in cervical and femoral vessels. Jeon et al. [9] compared the diameters of internal jugular phlebectasia with diameters of IJVs in normal children. Chao et al. [10] also compared the children with phlebectasia with the healthy volunteers as controls.

In this study, we aimed at determining the normal values of IJV sizes in healthy Turkish children. We used ultrasonography to measure the IJV diameters at rest and during Valsalva maneuver in normal children with no specific neck complaint.