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Q. Can you give me a medical opinion on CT angiogram?

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 06, 2018

Hello doctor,

Please, could you give your medical opinion on the following CT angiogram?

My query would be for you to look at the jugular veins which are near C1 in the neck. Symptoms have progressed over the course of four years, dizziness, neck pain, chronic headache, and collapse. The report has come back fine but would appreciate another opinion.

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hello,

Welcome to icliniq.com.

Please upload your CT angiogram images. I need to go through all the images in your CD DVD and will have a detailed look at the vessels near the C1 vertebra area including the jugular veins. Regards.

Revert with more information to a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist


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Thank you doctor,

Please find the files attached.

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hi,

Welcome back to icliniq.com.

I can see approximately 84 images of the CT neck and brain angiography (attachment removed to protect patient identity).

As you have rightly pointed out, there is some decrease in the lumen of the jugular veins at the level of C1 vertebra. One can say that the right internal jugular vein is completely collapsed in few images and the left vein is also narrowed and kind of compressed in reference image number 22/ 84 onwards.

Internal jugular veins carry blood from the head and neck areas to the heart. There are valves in the veins that allow the flow of blood in only one direction. Walls of the veins are not elastic and collapse when there is no blood flow. In the images of your scan, due to the combined effect of the venous return, the valves and the non-elastic walls of the veins, blood in the vein had still not reached the C1 area when the scan was taken and this is for less than a second. The CT scan machine is high speed and so this particular image was obtained. In other words, a normal jugular vein can be imaged in collapsed phase during a CT scan. It is interesting to know that a vein which does not collapse is abnormal and might be due to a clot within. Please do feel free to ask any queries. Regards.

For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist


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Thank you doctor,

My partner is very ill. What would you suggest? The local hospital will not look at the scan and sent him away with painkillers. What would you suggest?

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hello,

Welcome back to icliniq.com.

Sorry to know about your partner. Can you please give me details of the illness so that I can understand the problems in a better way. Please include what discussion you have had with the doctors and any clinical diagnosis which has been discussed.

Painkillers serve to help decrease many types of pain. I wish to know more in details about the pain and from when it is there. It is important to eliminate the cause of pain first and taking painkillers all the time is not of much help.

Please do write back with details. Regards.

For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist


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Thank you doctor,

He has chronic neck pain and headaches. His memory is very bad and often collapses. The physio feels that the C1 is compressing his internal jugular veins. I have attached some image for your opinion and closer inspection. The MRI was taken seven months ago. The radiologist said this was flow void artifact and nothing of concern. However, on the latest scans and views at different angles, 3D etc, it looks like there is compression on the jugulars. Please see attached images. A slice from the earlier MRI is included.

Dr. Vivek Chail

Radiodiagnosis Radiology
#

Hi,

Welcome back to icliniq.com.

After doing a close inspection of the images, I do feel that there is a possibility of the transverse processes of the atlas vertebra compressing on the internal jugular veins bilaterally.

This finding can cause venous outflow obstruction from the brain. This can be an important finding and needs to be discussed with the neurologist who has done the clinical examination.

Regards.

For more information consult a radiologist online --> https://www.icliniq.com/ask-a-doctor-online/radiologist


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