Communicating vein between the right external and internal jugular veins: a case report

The external jugular vein is a superficial vein that has a relatively diagonal to vertical course in the neck region and runs superficial to the sternocleidomastoid muscle. This vein is formed by the union of the posterior division of the retromandibular vein with the posterior auricular vein and it is responsible for draining most of the scalp and face as well. Sound knowledge of variations of the external jugular veins and the internal jugular veins, is important as these veins are used or targeted in specific medical procedures such as external jugular vein cannulation or radical neck dissection, respectively. During routine postgraduate dissection of the neck region in a 58-year-old female cadaver, the right external jugular vein was seen communicating with the right internal jugular vein via a communicating vein. The communicating vein was located approximately at the lower border of the thyroid cartilage and the upper border of the cricoid cartilage. A thorough understanding of anatomical variations is important in various medical disciplines and more specifically to anatomists, radiologists, and surgeons. This case report does not solely aim to increase awareness regarding variations of the jugular veins that can be possibly encountered during a neck endovascular procedure, but also contribute to the identification of the prevalence rate of this variation.

Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein mimicking a retroperitoneal lymphadenopathy: A case report

Introduction: Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein is extremely rare with only anecdotal reported cases. Unless detected and recognized promptly, this rare condition may give rise to severe bleeding in patients undergoing retroperitoneal surgery. It may also closely mimic enlarged retroperitoneal lymph nodes, paragangliomas, adrenal masses, or renal artery aneurysms. Case report: In this case study, we reported the imaging findings of this rare entity which was falsely diagnosed as enlarged retroperitoneal lymph node in an outside medical center, reported as to be consistent with metastatic disease, in a patient with newly diagnosed testicular cancer. Conclusion: The aneurysm of the communicating vein should be considered in the differential diagnosis in patients with testicular cancer and other disease processes where lymph nodes are commonly affected.

Left coronary cusp ablation to eliminate epicardial substrates – a novel strategy for left ventricular summit ventricular tachycardia ablation

Background Catheter ablation of LV summit VT can be challenging due to possible subepicardial or intramural site of origin and its close proximity to the major coronary vessels. Objective Local electrograms monitoring inside LV summit communicating vein potentially defines arrhythmogenic substrates and facilitates ablation from the adjacent anatomical structures. Results We experienced two cases of LV summit VT with epicardial local abnormal ventricular activities (Epi-LAVA) recorded from distal bipolar electrode of the 2F microcatheter in communicating vein close to the superior portion of LV summit. During sinus rhythm, Epi-LAVA displayed isolated late fractionated potentials in the first case but had initial fractionated potentials fused with terminal portion of far-field ventricular signals and late isolated potentials exhibiting 2:1 conduction in the second case. Epi-LAVA represented earliest ventricular signals during VT in both cases. Pace mapping at Epi-LAVA sites yielded single QRS morphology with excellent pacemap score and induced VT. Our strategy was to perform ablation at the facing site of Epi-LAVA aiming to eliminate the potentials transmurally. Radiofrequency (RF) energy was applied above and under the left coronary cusp opposite to Epi-LAVA sites using 3.5-mm tip open-irrigation catheter with a power of 30–35 W for 60 seconds under real-time intracardiac echocardiograhic guidance. VT was slowed and terminated in 1 second. Repeat ablation delayed and completely abolished Epi-LAVA followed by noninducibility of VT. Anatomical proximity of the left coronary cusp semilunar insertion and subepicardial or intramural site of origin possibly dictates successful ablation. Epi-LAVA from coronary vein mapping serve as a new landmark of the ablation target with a measurable procedural endpoint. Conclusion Elimination of epicardial substrates with RF energy application at the left coronary cusp can be a novel strategy for LV summit VT ablation. Funding Acknowledgement Type of funding source: None

Terminal bifurcation and unusual communication of left testicular vein with the left suprarenal vein

Variations of the testicular veins are relevant in clinical cases of varicocele and in other therapeutic and diagnostic procedures. We report herein on a unique variation of the left testicular vein observed in an adult male cadaver. The left testicular vein bifurcated to give rise to left and right branches which terminated by joining the left renal vein. There was also an oblique communication between the two branches of the left testicular vein. A slender communicating vein arose from the left branch of the left testicular vein and ascended upwards in front of the left renal vein and terminated into the left suprarenal vein. The right branch of the testicular vein received an unnamed adipose tributary from the side of the abdominal aorta. Awareness of these venous anomalies can help surgeons accurately ligate abnormal venous communications and avoid iatrogenic injuries and it is important for proper surgical management.