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DOI: 10.1148/rg.265055728
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Right arrow Magnetic Resonance Imaging
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Right arrow Head and Neck

It’s Not a Cervical Lymph Node, It’s a Vein: CT and MR Imaging Findings in the Veins of the Head and Neck1

Edward J. Escott, MD and Barton F. Branstetter, MD

1 From the Departments of Radiology (E.J.E., B.F.B.) and Otolaryngology (B.F.B.), University of Pittsburgh Medical Center, 200 Lothrop St, D-132, Pittsburgh, PA 15213-2582. Received October 20, 2005; revision requested January 17, 2006 and received March 7; accepted March 8. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Drawing illustrates the major venous drainage of the head and neck. The veins are shown in various shades of blue, with veins of a similar color representing the components of a major venous system. From darkest to lightest, these systems are the internal jugular vein and major central veins, the external jugular venous system and vertebral venous system, the posterior facial vein and tributaries, and the anterior facial vein and tributaries. Additional smaller veins are shown in purple.

 

Figure 2
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  		Figure 2a.  Course of the anterior facial vein. (a) Contrast material–enhanced CT scan obtained at the level of the inferior orbit shows the angular veins (arrows) along the sides of the nose. (b) Contrast-enhanced CT scan obtained at the level of the far inferior orbit shows the anterior facial veins (arrows) as a direct continuation of the angular veins. (c) Contrast-enhanced CT scan obtained at the level of the maxillary sinuses shows the anterior facial veins (arrows) coursing along the anterior aspect of the maxillae. (d) Contrast-enhanced CT scan obtained at the level of the maxillary alveolar ridge shows the anterior facial veins (arrows) coursing posteriorly.

 

Figure 2
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  		Figure 2b.  Course of the anterior facial vein. (a) Contrast material–enhanced CT scan obtained at the level of the inferior orbit shows the angular veins (arrows) along the sides of the nose. (b) Contrast-enhanced CT scan obtained at the level of the far inferior orbit shows the anterior facial veins (arrows) as a direct continuation of the angular veins. (c) Contrast-enhanced CT scan obtained at the level of the maxillary sinuses shows the anterior facial veins (arrows) coursing along the anterior aspect of the maxillae. (d) Contrast-enhanced CT scan obtained at the level of the maxillary alveolar ridge shows the anterior facial veins (arrows) coursing posteriorly.

 

Figure 2
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  		Figure 2c.  Course of the anterior facial vein. (a) Contrast material–enhanced CT scan obtained at the level of the inferior orbit shows the angular veins (arrows) along the sides of the nose. (b) Contrast-enhanced CT scan obtained at the level of the far inferior orbit shows the anterior facial veins (arrows) as a direct continuation of the angular veins. (c) Contrast-enhanced CT scan obtained at the level of the maxillary sinuses shows the anterior facial veins (arrows) coursing along the anterior aspect of the maxillae. (d) Contrast-enhanced CT scan obtained at the level of the maxillary alveolar ridge shows the anterior facial veins (arrows) coursing posteriorly.

 

Figure 2
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  		Figure 2d.  Course of the anterior facial vein. (a) Contrast material–enhanced CT scan obtained at the level of the inferior orbit shows the angular veins (arrows) along the sides of the nose. (b) Contrast-enhanced CT scan obtained at the level of the far inferior orbit shows the anterior facial veins (arrows) as a direct continuation of the angular veins. (c) Contrast-enhanced CT scan obtained at the level of the maxillary sinuses shows the anterior facial veins (arrows) coursing along the anterior aspect of the maxillae. (d) Contrast-enhanced CT scan obtained at the level of the maxillary alveolar ridge shows the anterior facial veins (arrows) coursing posteriorly.

 

Figure 3
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  		Figure 3.  Course of the anterior facial vein relative to the submandibular gland. Contrast-enhanced CT scan obtained at the level of the submandibular glands shows the right anterior facial vein (solid arrow) coursing along the superolateral aspect of the right submandibular gland. Note the anterior branch of the right posterior facial vein (dotted arrow) coursing along the posterior aspect of the submandibular gland.

 

Figure 4
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  		Figure 4.  Anterior facial vein as a landmark for differentiating intra- from extraglandular lesions. Contrast-enhanced CT scan obtained at the level of the submandibular glands shows the right anterior facial vein (dotted line) separating the right submandibular gland (SM) from adjacent abnormal lymph nodes (N).

 

Figure 5
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  		Figure 5.  Junction of the anterior facial vein and the anterior branch of the posterior facial vein to form the common facial vein. Contrast-enhanced CT scan shows the anterior facial veins (AFv) and the anterior (AB) and posterior (PB) branches of the posterior facial vein. The anterior facial vein and the anterior branch of the posterior facial vein join to form the common facial vein (CFv).

 

Figure 6
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  		Figure 6.  Common facial vein entering the internal jugular vein. Contrast-enhanced CT scan obtained at the level of the piriform sinuses shows the common facial vein (CFv) draining into the internal jugular vein (IJ).

 

Figure 7
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  		Figure 7a.  Formation of the posterior facial vein. (a) Contrast-enhanced CT scan obtained at the level of the right temporal scalp shows the frontal and parietal branches of the superficial temporal vein. (b) Contrast-enhanced CT scan obtained at the superior aspect of the parotid gland shows the main trunk of the right superficial temporal vein (ST v) just before it joins with the internal maxillary vein (IM v). The pterygoid venous plexus (arrows) lies medially.

 

Figure 7
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  		Figure 7b.  Formation of the posterior facial vein. (a) Contrast-enhanced CT scan obtained at the level of the right temporal scalp shows the frontal and parietal branches of the superficial temporal vein. (b) Contrast-enhanced CT scan obtained at the superior aspect of the parotid gland shows the main trunk of the right superficial temporal vein (ST v) just before it joins with the internal maxillary vein (IM v). The pterygoid venous plexus (arrows) lies medially.

 

Figure 8
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  		Figure 8a.  Posterior facial vein. (a) Contrast-enhanced CT scan shows the right posterior facial vein (retromandibular vein) (arrow) in the right parotid gland. (b) Contrast-enhanced CT scan obtained just inferior to a shows the anterior (dashed white arrow) and posterior (solid white arrow) branches of the right posterior facial vein to be nearly equal in size. The anterior facial vein (black arrow) courses posteriorly to join with the anterior branch of the posterior facial vein.

 

Figure 8
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  		Figure 8b.  Posterior facial vein. (a) Contrast-enhanced CT scan shows the right posterior facial vein (retromandibular vein) (arrow) in the right parotid gland. (b) Contrast-enhanced CT scan obtained just inferior to a shows the anterior (dashed white arrow) and posterior (solid white arrow) branches of the right posterior facial vein to be nearly equal in size. The anterior facial vein (black arrow) courses posteriorly to join with the anterior branch of the posterior facial vein.

 

Figure 9
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  		Figure 9a.  Posterior branch of the posterior facial vein and formation of the external jugular vein. (a) Contrast-enhanced CT scan shows the posterior auricular vein (dotted arrow) and the posterior branch of the posterior facial vein (solid arrow) in the right parotid gland. (b) Contrast-enhanced CT scan obtained just below the parotid gland shows the posterior branch of the posterior facial vein (solid arrow) and the posterior auricular vein (dotted arrow) joining to form the external jugular vein. (c) Contrast-enhanced CT scan obtained inferior to b shows the right external jugular vein (arrow) slightly below its origin, superficial to the sternocleidomastoid muscle (SCM).

 

Figure 9
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  		Figure 9b.  Posterior branch of the posterior facial vein and formation of the external jugular vein. (a) Contrast-enhanced CT scan shows the posterior auricular vein (dotted arrow) and the posterior branch of the posterior facial vein (solid arrow) in the right parotid gland. (b) Contrast-enhanced CT scan obtained just below the parotid gland shows the posterior branch of the posterior facial vein (solid arrow) and the posterior auricular vein (dotted arrow) joining to form the external jugular vein. (c) Contrast-enhanced CT scan obtained inferior to b shows the right external jugular vein (arrow) slightly below its origin, superficial to the sternocleidomastoid muscle (SCM).

 

Figure 9
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  		Figure 9c.  Posterior branch of the posterior facial vein and formation of the external jugular vein. (a) Contrast-enhanced CT scan shows the posterior auricular vein (dotted arrow) and the posterior branch of the posterior facial vein (solid arrow) in the right parotid gland. (b) Contrast-enhanced CT scan obtained just below the parotid gland shows the posterior branch of the posterior facial vein (solid arrow) and the posterior auricular vein (dotted arrow) joining to form the external jugular vein. (c) Contrast-enhanced CT scan obtained inferior to b shows the right external jugular vein (arrow) slightly below its origin, superficial to the sternocleidomastoid muscle (SCM).

 

Figure 10
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  		Figure 10.  External jugular venous system in the upper neck. Contrast-enhanced CT scan obtained at the level of the submandibular glands shows the left anterior jugular vein (AJ) and a branch (CB) from the common facial vein (CF) coursing medial to the submandibular gland toward the anterior jugular vein. The common facial vein continues caudally to drain into the internal jugular vein (IJ). EJ = external jugular vein.

 

Figure 11
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  		Figure 11a.  External jugular venous system in the lower neck to the external jugular terminus in the subclavian veins. (a) On a contrast-enhanced CT scan obtained at the level of the thyroid gland, the external jugular veins (solid arrows) are seen laterally. Note their reciprocal size relationship to the internal jugular veins (arrowheads). Note also the different degrees of venous enhancement: The larger left external jugular vein demonstrates soft-tissue attenuation, so that it could be mistaken for a lymph node on a single section. The left anterior jugular vein (open arrow) is seen crossing the sternocleidomastoid muscle posterolaterally and terminates in the left external jugular vein. Dashed arrows indicate duplicate right anterior jugular veins. (b) On a contrast-enhanced CT scan obtained at the level of the clavicles, the external jugular veins are seen terminating bilaterally in the subclavian veins (solid arrows). The internal jugular veins (arrowheads) are seen adjacent to the common carotid arteries (open arrows).

 

Figure 11
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  		Figure 11b.  External jugular venous system in the lower neck to the external jugular terminus in the subclavian veins. (a) On a contrast-enhanced CT scan obtained at the level of the thyroid gland, the external jugular veins (solid arrows) are seen laterally. Note their reciprocal size relationship to the internal jugular veins (arrowheads). Note also the different degrees of venous enhancement: The larger left external jugular vein demonstrates soft-tissue attenuation, so that it could be mistaken for a lymph node on a single section. The left anterior jugular vein (open arrow) is seen crossing the sternocleidomastoid muscle posterolaterally and terminates in the left external jugular vein. Dashed arrows indicate duplicate right anterior jugular veins. (b) On a contrast-enhanced CT scan obtained at the level of the clavicles, the external jugular veins are seen terminating bilaterally in the subclavian veins (solid arrows). The internal jugular veins (arrowheads) are seen adjacent to the common carotid arteries (open arrows).

 

Figure 12
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  		Figure 12.  Formation of the internal jugular vein. Contrast-enhanced CT scan shows the right internal jugular vein (IJ) in the jugular foramen and the sigmoid sinus (SS) draining into the vein.

 

Figure 13
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  		Figure 13a.  Variations in the emissary veins and dural venous sinuses: inferior petrosal sinus. Three-dimensional contrast-enhanced spoiled gradient-recalled acquisition in the steady state MR images (25/5) (b obtained inferior to a) show a large right inferior petrosal sinus (arrow) extending inferiorly and laterally toward the jugular bulb.

 

Figure 13
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  		Figure 13b.  Variations in the emissary veins and dural venous sinuses: inferior petrosal sinus. Three-dimensional contrast-enhanced spoiled gradient-recalled acquisition in the steady state MR images (25/5) (b obtained inferior to a) show a large right inferior petrosal sinus (arrow) extending inferiorly and laterally toward the jugular bulb.

 

Figure 14
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  		Figure 14.  Terminus of the internal jugular vein. Contrast-enhanced CT scan obtained at the level of the clavicles shows the right internal jugular vein (IJ) joining with the subclavian vein (SC) to form the brachiocephalic vein.

 

Figure 15
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  		Figure 15.  Vertebral venous system: internal and external venous plexuses. Contrast-enhanced fat-saturated T1-weighted MR image (repetition time msec/echo time msec =550/10) obtained at the level of C2 shows the anterior internal vertebral venous plexus (solid arrow) with anastomoses (dashed arrow) to the external vertebral venous plexus.

 

Figure 16
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  		Figure 16.  Vertebral venous system: vertebral artery venous plexus. Contrast-enhanced CT scan obtained through the midcervical region shows the vertebral artery venous plexus and intervertebral veins (black arrow) in the right transverse foramen. White arrow indicates the vertebral artery.

 

Figure 17
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  		Figure 17a.  Vertebral venous system in the lower neck. (a) Contrast-enhanced CT scan obtained at the level of C7 shows the reflux of contrast material into the internal vertebral venous plexus (black arrows). Note the collateral vessels (intervertebral veins) (white arrow) coursing to the external vertebral venous plexus–vertebral vein and the formation of the vertebral vein as it exits the transverse foramen (arrowhead). (b) Contrastenhanced CT scan obtained caudad to a shows the vertebral veins (solid arrows) coursing anteriorly. The right vertebral artery (dotted arrow) is seen anterior to the corresponding vertebral vein.

 

Figure 17
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  		Figure 17b.  Vertebral venous system in the lower neck. (a) Contrast-enhanced CT scan obtained at the level of C7 shows the reflux of contrast material into the internal vertebral venous plexus (black arrows). Note the collateral vessels (intervertebral veins) (white arrow) coursing to the external vertebral venous plexus–vertebral vein and the formation of the vertebral vein as it exits the transverse foramen (arrowhead). (b) Contrast-enhanced CT scan obtained caudad to a shows the vertebral veins (solid arrows) coursing anteriorly. The right vertebral artery (dotted arrow) is seen anterior to the corresponding vertebral vein.

 

Figure 18
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  		Figure 18.  Variations in the emissary veins and dural venous sinuses: anterior condylar vein. Contrast-enhanced CT scan shows enlargement of the right hypo-glossal canal with an associated enlarged anterior condylar vein (varix) (arrow).

 

Figure 19
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  		Figure 19.  Variations in the emissary veins and dural venous sinuses: mastoid emissary vein. Axial three-dimensional time-of-flight MR angiographic image (30/3) shows a large mastoid emissary vein (arrow) with flow-related enhancement.

 

Figure 20
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  		Figure 20.  Common facial vein mimicking a lymph node. On a contrast-enhanced CT scan obtained at the level of the inferior aspect of the submandibular glands, the left common facial vein (solid arrow) is larger and enhances less than its contralateral counterpart (*), and thus could be mistaken for an enlarged lymph node. The vein was confirmed as such on the basis of its draining into the internal jugular vein on inferior images and its being formed by the anterior facial vein and the anterior branch of the posterior facial vein on superior images. The right common facial vein is seen draining into the internal jugular vein (dashed arrow).

 

Figure 21
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  		Figure 21.  Vein simulating a lymph node. Unenhanced CT scan of the neck shows a large left anterior jugular vein or distal common facial vein (arrow), a finding that was initially thought to represent a lymph node. The finding was confirmed to be a vein on the basis of its continuity with adjacent vessels. Because of contrast bolus timing or lack of contrast, veins can have different degrees of enhancement or attenuation similar to that of soft tissue, and, when asymmetric, they can simulate nodes.

 

Figure 22
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  		Figure 22a.  Variant course of the external jugular vein. (a) Initial unenhanced CT scan shows rounded structures (arrows) along the anterior aspects of the anterior scalene muscles. These findings might be mistaken for a pathologic process if unilateral but probably would not be misconstrued in this case because they are symmetric. Arrowheads indicate the internal jugular veins. (b, c) Contrast-enhanced CT scans reveal that the rounded structures in a represent the external jugular veins (arrows). These veins enhance somewhat less than the other veins due to contrast bolus timing and are seen to cross medially and to terminate atypically in the internal jugular veins (arrowheads) (c). The external jugular veins normally terminate in the subclavian veins.

 

Figure 22
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  		Figure 22b.  Variant course of the external jugular vein. (a) Initial unenhanced CT scan shows rounded structures (arrows) along the anterior aspects of the anterior scalene muscles. These findings might be mistaken for a pathologic process if unilateral but probably would not be misconstrued in this case because they are symmetric. Arrowheads indicate the internal jugular veins. (b, c) Contrast-enhanced CT scans reveal that the rounded structures in a represent the external jugular veins (arrows). These veins enhance somewhat less than the other veins due to contrast bolus timing and are seen to cross medially and to terminate atypically in the internal jugular veins (arrowheads) (c). The external jugular veins normally terminate in the subclavian veins.

 

Figure 22
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  		Figure 22c.  Variant course of the external jugular vein. (a) Initial unenhanced CT scan shows rounded structures (arrows) along the anterior aspects of the anterior scalene muscles. These findings might be mistaken for a pathologic process if unilateral but probably would not be misconstrued in this case because they are symmetric. Arrowheads indicate the internal jugular veins. (b, c) Contrast-enhanced CT scans reveal that the rounded structures in a represent the external jugular veins (arrows). These veins enhance somewhat less than the other veins due to contrast bolus timing and are seen to cross medially and to terminate atypically in the internal jugular veins (arrowheads) (c). The external jugular veins normally terminate in the subclavian veins.

 

Figure 23
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  		Figure 23a.  Internal jugular venous pseudoaneurysm mimicking a mass. The patient, who had undergone multiple renal transplantations and placement of central catheters, presented with a right-sided neck mass that changed in size with changes in his position. (a) Initial unenhanced CT scan obtained at the base of the neck shows a "mass" (arrow) lateral to the right internal jugular vein (arrowhead). The "mass" was initially interpreted as a level 4 node. (b) On a follow-up contrast-enhanced CT scan, the "mass" (large arrow) shows enhancement similar to that of the adjacent internal jugular vein (arrowhead) and communicates with the vein. The findings lateral to the left internal jugular vein likely represent a combination of an additional small pseudoaneurysm, small nodes, and possibly a dilated distal thoracic duct (small arrows). (c) Inhomogeneously fat-saturated T2-weighted MR image (3667/99) shows a "flow void" within the "mass" (arrow), with an appearance similar to that of the adjacent internal jugular vein (arrowhead). This finding confirmed the vascular nature of the "mass," which presumably represents a venous pseudoaneurysm related to prior catheter placement. Venous pseudoaneurysm is an uncommon complication of internal jugular vein catheterization (13).

 

Figure 23
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  		Figure 23b.  Internal jugular venous pseudoaneurysm mimicking a mass. The patient, who had undergone multiple renal transplantations and placement of central catheters, presented with a right-sided neck mass that changed in size with changes in his position. (a) Initial unenhanced CT scan obtained at the base of the neck shows a "mass" (arrow) lateral to the right internal jugular vein (arrowhead). The "mass" was initially interpreted as a level 4 node. (b) On a follow-up contrast-enhanced CT scan, the "mass" (large arrow) shows enhancement similar to that of the adjacent internal jugular vein (arrowhead) and communicates with the vein. The findings lateral to the left internal jugular vein likely represent a combination of an additional small pseudoaneurysm, small nodes, and possibly a dilated distal thoracic duct (small arrows). (c) Inhomogeneously fat-saturated T2-weighted MR image (3667/99) shows a "flow void" within the "mass" (arrow), with an appearance similar to that of the adjacent internal jugular vein (arrowhead). This finding confirmed the vascular nature of the "mass," which presumably represents a venous pseudoaneurysm related to prior catheter placement. Venous pseudoaneurysm is an uncommon complication of internal jugular vein catheterization (13).

 

Figure 23
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  		Figure 23c.  Internal jugular venous pseudoaneurysm mimicking a mass. The patient, who had undergone multiple renal transplantations and placement of central catheters, presented with a right-sided neck mass that changed in size with changes in his position. (a) Initial unenhanced CT scan obtained at the base of the neck shows a "mass" (arrow) lateral to the right internal jugular vein (arrowhead). The "mass" was initially interpreted as a level 4 node. (b) On a follow-up contrast-enhanced CT scan, the "mass" (large arrow) shows enhancement similar to that of the adjacent internal jugular vein (arrowhead) and communicates with the vein. The findings lateral to the left internal jugular vein likely represent a combination of an additional small pseudoaneurysm, small nodes, and possibly a dilated distal thoracic duct (small arrows). (c) Inhomogeneously fat-saturated T2-weighted MR image (3667/99) shows a "flow void" within the "mass" (arrow), with an appearance similar to that of the adjacent internal jugular vein (arrowhead). This finding confirmed the vascular nature of the "mass," which presumably represents a venous pseudoaneurysm related to prior catheter placement. Venous pseudoaneurysm is an uncommon complication of internal jugular vein catheterization (13).

 

Figure 24
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  		Figure 24a.  Vertebral vein varix. (a) Unenhanced CT scan of the spine shows an apparent varix (white arrow) of the left vertebral vein, a finding that was initially thought to represent either an enlarged lymph node or an aneurysm of the left subclavian artery (black arrow) or vertebral artery. The patient later returned for CT angiographic evaluation. (b) CT angiogram shows pooling of contrast material in the varix (white arrow), which demonstrates enhancement different from that of the adjacent arteries (black arrow). (c) CT angiogram obtained just above the varix shows the left vertebral vein (white arrow) posterior to the left vertebral artery (black arrow).

 

Figure 24
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  		Figure 24b.  Vertebral vein varix. (a) Unenhanced CT scan of the spine shows an apparent varix (white arrow) of the left vertebral vein, a finding that was initially thought to represent either an enlarged lymph node or an aneurysm of the left subclavian artery (black arrow) or vertebral artery. The patient later returned for CT angiographic evaluation. (b) CT angiogram shows pooling of contrast material in the varix (white arrow), which demonstrates enhancement different from that of the adjacent arteries (black arrow). (c) CT angiogram obtained just above the varix shows the left vertebral vein (white arrow) posterior to the left vertebral artery (black arrow).

 

Figure 24
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  		Figure 24c.  Vertebral vein varix. (a) Unenhanced CT scan of the spine shows an apparent varix (white arrow) of the left vertebral vein, a finding that was initially thought to represent either an enlarged lymph node or an aneurysm of the left subclavian artery (black arrow) or vertebral artery. The patient later returned for CT angiographic evaluation. (b) CT angiogram shows pooling of contrast material in the varix (white arrow), which demonstrates enhancement different from that of the adjacent arteries (black arrow). (c) CT angiogram obtained just above the varix shows the left vertebral vein (white arrow) posterior to the left vertebral artery (black arrow).

 

Figure 25
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  		Figure 25.  Jugular phlebectasia. Contrast-enhanced CT scan through the lower neck shows a focally dilated right internal jugular vein IJ (r) (jugular phlebectasia) and a much smaller left internal jugular vein IJ (l).

 

Figure 26
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  		Figure 26.  Cavernous sinus air. CT scan obtained at the level of the cavernous sinus shows air bubbles (arrows) bilaterally within the cavernous sinuses.

 

Figure 27
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  		Figure 27a.  Variable appearance of veins at MR imaging. (a) T2-weighted MR image (3417/101) obtained at the level of the thoracic inlet shows variable signal intensity of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins. Note that the right internal jugular vein contains a low-signal-intensity "flow void," the left internal jugular vein has intermediate signal intensity, and the vertebral veins have varying degrees of increased signal intensity. The common carotid arteries (anterior to the vertebral veins) had "flow voids" with all sequences. (b) Unenhanced T1-weighted MR image (600/10) also shows variable signal intensity of the internal jugular (straight arrows) and vertebral (bent arrows) veins. (c) Contrast-enhanced fat-saturated T1-weighted MR image (567/12) shows variable enhancement of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins.

 

Figure 27
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  		Figure 27b.  Variable appearance of veins at MR imaging. (a) T2-weighted MR image (3417/101) obtained at the level of the thoracic inlet shows variable signal intensity of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins. Note that the right internal jugular vein contains a low-signal-intensity "flow void," the left internal jugular vein has intermediate signal intensity, and the vertebral veins have varying degrees of increased signal intensity. The common carotid arteries (anterior to the vertebral veins) had "flow voids" with all sequences. (b) Unenhanced T1-weighted MR image (600/10) also shows variable signal intensity of the internal jugular (straight arrows) and vertebral (bent arrows) veins. (c) Contrast-enhanced fat-saturated T1-weighted MR image (567/12) shows variable enhancement of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins.

 

Figure 27
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  		Figure 27c.  Variable appearance of veins at MR imaging. (a) T2-weighted MR image (3417/101) obtained at the level of the thoracic inlet shows variable signal intensity of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins. Note that the right internal jugular vein contains a low-signal-intensity "flow void," the left internal jugular vein has intermediate signal intensity, and the vertebral veins have varying degrees of increased signal intensity. The common carotid arteries (anterior to the vertebral veins) had "flow voids" with all sequences. (b) Unenhanced T1-weighted MR image (600/10) also shows variable signal intensity of the internal jugular (straight arrows) and vertebral (bent arrows) veins. (c) Contrast-enhanced fat-saturated T1-weighted MR image (567/12) shows variable enhancement of the internal jugular (straight solid arrows), anterior jugular (dotted arrows), and vertebral (bent solid arrows) veins.

 




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