Supraclavicular Course of Left External Jugular Vein
Fisher, Cara Ph.D
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Background: The external jugular vein is formed by the union of posterior division of retromandibular vein and posterior auricular vein. Variant drainage of the venous system is common and has been discussed at length in anatomical journals and textbooks. However, variations in the drainage of the EJV is uncommon and as such there are limited reports of this specific anomaly. We report a rare case of unilateral left EJV drainage that coursed superficial to the left clavicle and then proceeded to drain into the left subclavian vein. Case Information: During routine dissection of a 70-year-old African-American male cadaver, a unilateral variation in the left external jugular vein (EJV) was noted. This variant EJV was found to descend superficial to the left clavicle and then proceeded to drain into the left subclavian vein. This is a deviation from the typical left EJV path which normally courses posterior and deep to the clavicle before draining into the left subclavian vein. This cadaver was an African-American male and as such the variant was not noted on pre-dissection integumentary exam. It is unclear whether he possessed knowledge of his anomaly. We were unable to obtain a full medical history for the cadaver; however, the cause of death was determined to be metastatic esophageal cancer. Conclusions: Anatomical variations of the EJV may pose certain health risks increase the complexity of various surgical procedures. The EJV is commonly used as an indicator for increased central venous pressure which can be used concordantly with other symptoms for the diagnosis of: right-sided heart failure, pulmonary hypertension, or tricuspid valve stenosis. Knowledge of the EJV and its common variants is important for clinicians and surgical specialists. Surgeons performing placement of pacemaker leads or implantable cardioverter defibrillators should be acutely aware of the EJV and its variants to reduce complications and improve patient outcomes. Patients and individuals possessing this EJV variation may be at increased risk of adverse outcomes in the event they were to fracture their clavicle. The clavicle is the most commonly fractured bone in the body and the middle third is the most fractured segment, where this variant was noted. Notching of the clavicle was noted where the EJV passed superficial to it. We postulate this may be due to increased pressure from its tortuous path as well as aberrant development due to the mobility of the clavicle.