Single-Centre Retrospective Study Using Propensity Score Matching Comparing Left Versus Right Internal Jugular Vein Access for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation

Purpose To compare the safety and efficacy of left versus right internal jugular vein access for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with a small liver and short vertical puncture distance. Materials and Methods The vertical distance from the hepatic vein orifice to the puncture point of the portal vein was measured by CT and DSA. A distance ≤ 30 mm is defined as a short vertical puncture distance. After 1:1 propensity score matching (PSM), 29 patients of left internal jugular vein-TIPS (LIJ-TIPS) and 29 patients of right internal jugular vein-TIPS (RIJ-TIPS) were included. The number of needle punctures, fluoroscopy time, and radiation dose during the puncture process were statistically analyzed. Results There was no significant difference in the average vertical puncture distances on CT or DSA between LIJ-TIPS and RIJ-TIPS (19.10 ± 0.60 mm vs. 19.30 ± 0.60 mm, P = 0.840; 22.02 ± 0.69 mm vs. 22.23 ± 0.64 mm, P = 0.822, respectively). The average number of needle punctures, fluoroscopy time, and radiation dose in LIJ-TIPS were significantly lower than those in RIJ-TIPS (2.07 ± 0.20 vs. 4.10 ± 0.24, P < 0.001; 78.45 ± 12.80 s vs. 201.16 ± 23.71 s, P < 0.001; 31.55 ± 7.04 mGy vs. 136.69 ± 16.38 mGy, P < 0.001, respectively). Within three punctures, the technical success rate in LIJ-TIPS was significantly higher than that in RIJ-TIPS (86.2 vs. 27.6%, P < 0.001). The incidence of hemoperitoneum in LIJ-TIPS was significantly lower than that in RIJ-TIPS (0% vs. 13.8%, P = 0.038). Conclusion The left internal jugular vein could be used as primary access for TIPS creation in patients with a small liver and short vertical puncture distance.

Chryseobacterium indologenes Infection in an Immunocompromised Patient - A Rare Case Report

A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.

The road less travelled: percutaneous closure of a secundum atrial septal defect through the left internal jugular vein

In cases where femoral access is untenable for secundum atrial septal defect closure, the internal jugular vein can be used instead. We report a case of atrial septal defect closure in a patient with significant vascular thrombosis, requiring the use of the left internal jugular vein for access. To the best of our knowledge, this is the first report that documents the use of the left internal jugular vein for atrial septal defect closure in a patient with situs solitus anatomy.

Mind the gap: life-threatening retropharyngeal haematoma resulting in acute airway obstruction following blunt trauma by closing train carriage doors

Delayed life-threatening airway obstruction due to venous injury following blunt, non-penetrative trauma to the neck. A rare case of rapid force, blunt trauma by closing train carriage doors, leading to injury to the left internal jugular vein, subsequent retropharyngeal haematoma and airway obstruction. There was a significant delay of a few hours between injury and acute deterioration. Initial dual Phase CT (unenhanced and arterial) studies identified the large retropharyngeal haematoma but the assessment of the source was inconclusive likely due to the venous injury becoming compressed by the swelling/haematoma at the time of investigation. Subsequent triple phase (unenhanced, arterial and venous) studies were performed identifying a flap in the left internal jugular vein as the likely site of vascular injury. A venous origin of haemorrhage supported the patients delayed onset of symptoms following the injury. We suggest with blunt force trauma to the neck, in the context of suspicion of haematoma and airway compromise, the radiologist should consider protocolling a triple phase (unenhanced, arterial and venous) angiographic study.

Neck Swelling in A Child: Now You See it, Now You Don’t?

Jugular Ectasia is a rare benign swelling due to dilatation of jugular vein, which can occur in the internal, external or an anterior jugular vein. It is characterized by painless, soft, compressible unilateral swelling appeared on Valsalva maneuver. A 3-year-old boy presented with 2 months history of prominent mass over the right side of the neck on Valsalva maneuver is subjected to Doppler ultrasonography (USG) of the neck. Doppler Ultrasonography (USG) of the neck revealed prominent right jugular dilatation during Valsalva without any focal lesion with the normal caliber of the left internal jugular vein. Jugular ectasia should be included in the differentials of a benign neck swelling in children despite infrequently encountered. Dilated jugular vein on ultrasound Doppler on Valsalva maneuver is pathognomic of jugular ectasia. Early diagnosis with serial follow up can reduce parent’s anxiety and will reduce complications.