Abstract
IntroductionUnawareness of an asymmetry between the right and left internal jugular vein (IJV) and methodological pitfalls in previous studies raise concerns about such asymmetry. Hence the aim of this prospective non-interventional study was to validate the hypothesis that right IJV diameter is greater than those of left IJV and to determine the cross-sectional area of the IJVs using computed tomography (CT)-scans and original automatic software.MethodsAll consecutive adult outpatients who underwent a thoracic contrast-enhanced (TCE) helical CT-scan during a 5-month period were included. To determine diameter and cross sectional area of the IJVs, we used Advanced Vessel Analysis software integrated in a CT-scan (Advanced Vessel Analysis on Advantage Workstation Windows 4.2; General Electrics) allowing automatic segmentation of vessels and calculation of their diameters and cross-sectional areas.ResultsA total of 360 TCE CT-scans was performed; 170 were excluded from the analysis. On the remaining 190 CT scans, the diameter and cross-sectional area of the right IJV were significantly greater than those of the left IJV (17 ± 5 mm [median: 17 mm, range: 13 to 20 mm] vs. 14 ± 5 mm [median: 13 mm, range: 10 to 16 mm], P < 0.001; and 181 ± 111 mm2 [median: 160 mm2, range: 108 to 235 mm2] vs. 120 ± 81 mm2 [median: 102 mm2, range: 63 to 168 mm2], P < 0.001, respectively).ConclusionsIn a general population of adult outpatients, the diameter and cross-sectional area of the right IJV were significantly greater than those of the left IJV. This could be an additional argument to prefer right over left IJV cannulation.
Highlights
Unawareness of an asymmetry between the right and left internal jugular vein (IJV) and methodological pitfalls in previous studies raise concerns about such asymmetry
A total of 360 thoracic contrast-enhanced (TCE) computed tomography (CT) scans were performed during the study period; 170 were excluded from the analysis (problem with radio-contrast injection (n = 54), inappropriate CT scan sections (n = 108), internal jugular and subclavian catheters previously in place (n = 3), superior vena cava thrombosis (n = 1), no visible left IJV (n = 1), right pneumonectomy (n = 1), compressive mediastinal mass (n = 1), thyroidectomy (n = 1))
Right IJV cross-sectional area was greater than left IJV area in 71% of patients and was 1.5- and 2.0-times in 54% and 34% of cases, respectively
Summary
Unawareness of an asymmetry between the right and left internal jugular vein (IJV) and methodological pitfalls in previous studies raise concerns about such asymmetry. Lobato and colleagues showed that the cross-sectional area of the right IJV was greater than that of the left IJV in the majority (80%) of 50 healthy volunteers [3]. Such asymmetry has been confirmed in intensive care patients, where the right IJV was equal or dominant in 62.5% of patients [4]. In these two ultrasound studies, the precise diameter and cross-sectional area of the right and left IJV were not reported. The cross-sectional area was not measured and CT: computed tomography; IJV: internal jugular vein; TCE: thoracic contrast-enhanced
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