JUGULAR VEINS

From Big Medical Encyclopedia

JUGULAR VEINS (venae jugulares) — the pair veins which are taking away blood from bodies of the head and neck in brachiocephalic veins which, in turn, fall into an upper vena cava. I. collect blood from bodies and fabrics century, blood supply to-rykh is carried out preferential from systems of carotid and vertebral arteries. Allocate deeply located wider internal jugular vein (v. jugularis int.), superficially lying an outside (back) jugular vein (v. jugularis ext.) and front jugular vein (v. jugularis ant.). The big contribution to studying of anatomy of jugular veins was made by M. A. Tikhomirov, A.S. Vishnevsky, A. N. Maksimenkova

V. M. Romankevich, etc.

At fishes, amphibians and reptiles blood from the head flows on front cardinal, or jugular, to veins. Mammals in the head and a neck, in addition to deep veins, have large saphenas which are transformed in outside and front I. century.

In ontogenesis at the person inner selves. develop from front departments of cardinal veins century, to-rye are formed at an embryo at merge of veins of the head (vv. capitis). Outside and front I. form later from small vessels in maxillary and submaxillary areas century. On 8 to week of development the left front cardinal vein connects to the right cardinal vein at the expense of an anastomosis, to-ry turns in the subsequent into the left brachiocephalic vein. The site of the right cardinal vein from the conjunction right subclavial and internal jugular veins to the specified anastomosis gives rise to the right brachiocephalic vein.

Internal I. takes away blood from a brain and its covers, an eye and tissues of an eye-socket, walls of a skull and a nasal cavity, a throat, language and other bodies of the head and neck century. It begins in a jugular foramen of a skull, being continuation of a sigmoid sine of a firm cover of a brain (tsvetn. tab., Art. 464, fig. 8). An upper part of a vein has expansion — an upper bulb of an internal jugular vein (bulbus venae jugularis superior).

At the conjunction with a subclavial vein internal I. forms the second, larger expansion century — the lower bulb of an internal jugular vein (bulbus venae jugularis inferior). On the way down the vein passes behind an internal carotid artery, then sideways from it, and in a lower part of a neck — lateralno from the general carotid artery. Behind and medially from a vein the vagus nerve (n. vagus) is located. General carotid artery, vagus nerve and internal I. form the neurovascular bunch surrounded with a connective tissue vagina (vagina carotica) century.

Internal I. has 2 — 3 valves century, one of to-rykh is from the lower bulb of an internal jugular vein from top to bottom. Right internal I. is, as a rule, wider than left century. Inflows internal I. subdivide on intracranial and extracranial century. Sine of a firm meninx and a vein of a tubule of a snail (v. canaliculi cochleae) concern to the first. Out of a head cavity in internal I. century pharyngeal veins fall (vv. pha-ryngeae), meningeal veins (vv. meningeae), lingual vein (v. lingua-lis), upper guttural vein (v. laryngea superior), upper and average thyroid veins (vv. thyroi-deae superior et medii), grudino - clavicular and mastoidal veins (vv. sternocleidomastoideae). Diameter internal I. century, the topography of its inflows and an anastomosis with other jugular veins can widely vary (tsvetn. the tab., Art. 464, fig. 10 — 11). Top and bottom expansions internal I. century sometimes are absent. In the presence of a large lobby I. century the left internal jugular vein has small diameter. The most often internal I. anastomoses in occipital area with inflows of a subclavial vein, with deep veins of a neck and vertebral veins, with deep and superficial veins of a back century. In 1949. A.S. Vishnevsky and A. N. Makei-menkov established that options internal I. century and its inflows are caused by extent of reorganization of primary venous network in a neck.

Outside I. century superficially lying vessel on a neck represents the largest, on Krom blood flows from skin, hypodermic cellulose and muscles occipital and mastoidal areas (pozadiushny) heads, from fabrics of deep temporal area, the person, front and posterolateral departments of a neck. Outside I. forms under an auricle at the level of a corner of a mandible at merge of a back ear vein century (v. auricularis post.), formed of a mastoidal emissarny vein (v. emissaria mastoidea) and an occipital vein (v. occipitalis), with a zanizhnechelyustny vein (v. retromandibularis). Then outside I. century the outer surface of a grudinoklyuchichno-mastoidal muscle goes down, being located directly under a hypodermic muscle of a neck. Approximately in the middle grudino - a clavicular and mastoidal muscle outside I. reaches its outer edge century and in the field of the corner formed by the outer edge of this muscle and a clavicle leaves deep into under the lower abdomen of a lopatochnopodjyazychny muscle. In this place outside I. probodat superficial and pretracheal plates of a cervical fascia century and falls into a subclavial vein, or into an internal jugular vein, or into the corner formed at connection of these veins (a venous corner). In outside I. century on the way of its following cross veins of a neck fall (vv. transversae colli) and a nadlopatochny vein (v. sup-rascapularis), to-rye form in the field of a branching of the arteries of the same name, and also a lobby I. century, the taking-away blood from front area of a neck (tsvetn. tab., Art. 464, fig. 9). In one cases outside I. has loose type of formation century, at Krom saphenas on a neck form the shirokopetlisty network which is plentifully anastomosing with inflows subclavial, internal jugular and other deep veins of a neck. In others — outside, and also a lobby I. represent large venous vessels with a small amount of an anastomosis between them century.

Lobby I. is the largest inflow of an outside jugular vein century. It is formed from subcutaneously the located veins of mental area anastomosing with inflows of a facial vein. Further lobby I. goes down sideways from a front midline of a neck, on an outer surface of a maxillary and hypoglossal muscle century in the beginning, and then — grudino-podjyazych-ache muscles. 3 — 4 cm above jugular cutting of a breast the vein probodat a superficial plate of a cervical fascia, gets into a nadgrudinny interfascial interval, abruptly turns lateralno, probodat a pretracheal leaf of a cervical fascia and falls into an outside jugular vein. In subclavial and brachiocephalic veins a lobby I. falls century seldom. In a nadgrudinny inter-fascial interval the right and left lobbies I. connect a cross anastomosis, to-ry together with the distal pieces of lobbies located in this interval I century. forms the jugular venous arch (arcus venosus juguli) opened down century. The setevidny structure of a front jugular vein is sometimes observed. In these cases one or both lobbies I. are developed century poorly, and superficial veins of front area of a neck are presented by the numerous thin plentifully anastomosing venous vessels. Sometimes ahead on a neck there is one unpaired (median) vein, edges can fall into the right or left outside jugular vein, in subclavial or into the left brachiocephalic.

Pathology I. includes malformations, diseases and damages century.

Malformations. Among malformations there are I. century ectasia and aneurisms meet more often (especially internal I. century), the formations of a wall of a vein or its valves which are usually caused by defect. More rare this pathology happens is connected with an ekstravazalny prelum of a vein. On inborn pathology I. century, as a rule, the first parents pay attention, to-rye notice that during the crying or shout of the child it on a neck has a tumorous education. This education also arises or increases at a natuzhivaniye, an inclination of a trunk forward and quickly disappears or considerably decreases in sizes at the termination of tension or straightening of a trunk of the patient. At a palpation tumorous education has a myagkoelastichesky consistence and decreases during the pressing. Ectasia outside I. century usually is located knaruzh from grudino - a clavicular and mastoidal muscle in supraclavicular area, aneurism internal I. it is localized medialny or under a grudinoklyuchichno-mastoidal muscle century.

The diagnosis in typical cases can be established already at survey and conducting tests with I natuzhivani-eat, at to-rykh considerable protrusion of the changed sites of a jugular vein is noted. Apply such special methods of a research as an ultrasonic floumetriya and an ultrasonic angiography (see. Ultrasonic diagnosis) allowing to determine diameter of its gleam and speed of a blood-groove without puncture of a vessel. Similar information can be obtained at an angiostsintigrafiya after intravenous administration of radio headlights-matsevtichesky drug, radiation to-rogo is registered by means of the special gamma camera supplied with the computer device. Increase in diameter of a vein can be established also at a computer tomography (see the Tomography computer) and emission tomography. The flebografiya allows to receive a detailed topical picture of defeat (see). For its carrying out catheterize a femoral vein on Seldin-gera and carry out a catheter to an internal jugular vein, but also introduction of a catheter through a subclavial vein is possible (see Catheterization of veins puncture). During the conducting test with a natu-zhivaniye enter radiopaque substance and carry out a X-ray analysis of area of a neck.

Ectasia or aneurism I. it is necessary to differentiate with other vascular defeats century — a hemangioma (see), a lymphangioma (see), arterial or arteriovenous aneurism (see), pathological crimpiness of a carotid artery or brachiocephalic trunk. At a palpation these educations have big density, and over formations of arterial genesis the clear pulsation is noted. Besides, by means of ultrasonic investigation at the listed diseases partitions or additional inclusions in a gleam patol can be revealed. the center, and the wall it usually has big thickness. The diagnosis is specified by means of an angiography (see). In differential diagnosis with a side cyst of a neck (see), a paraganglioma (see) and lymphadenitis (see) it is necessary to consider that these educations do not change the form at change of position of a body of the patient and at a natu-zhivaniye. At a palpation these educations have usually big density, the pulsation is absent. In doubtful cases resort to ultrasonic, radio isotope and angiographic researches.

At the increase in the sizes of the site of an ectasia or aneurism of a jugular vein caused irreversible morfol. changes of a vascular wall, and also at danger of complications (fibrinferments, a rupture of aneurism) and major cosmetic defect resort to operational treatment. Earlier at aneurism outside I. carried out its resection century, and at aneurism internal I. century — its enveloping, side excision or suture on a wall of a vein. In a crust, time consider that radical operation — a resection of aneurism with imposing of an anastomosis the end in the end is most effective. At timely treatment the forecast, as a rule, favorable.

Diseases. Among acquired diseases the greatest value have thrombophlebitis (see), thrombosis (see) and secondary occlusion I. century as a result of a prelum of a vein or germination of a tumor in it.

Thrombophlebitis I. can arise at long catheterization of veins century, and also after an acute periphlebitis (see Phlebitis) at tonsillitis (see), otitis (see) or retropharyngeal abscess (see). Patients complain of pains on the course of a vein, sometimes of difficulty during the swallowing. In case of thrombophlebitis outside I. century the dermahemia on the course of a vein is noted, at a palpation find painful consolidation in a projection of a vessel. Acute purulent thrombophlebitis internal I. is followed by high temperature of a body, an oznobama century. Mobility of the head and neck is limited because of pains and hypostasis of fabrics of a side surface of a neck. At a palpation reveal sharp morbidity on the course of a grudino-klyuchichnosostsevidny muscle. The diagnosis is specified by means of ultrasonic investigation and an angiostsintigrafiya.

Occlusion internal I. century as a result of incremental thrombosis or a prelum is followed a tumor by hypostasis of the corresponding half of the face and a neck. Hypostasis is usually expressed in the mornings and when the patient lies on the struck party. If occlusion I. extends on front and eye veins century, the exophthalmos with hypostasis develops a century. Thanks to the developed collateral bonds between internal and outside I. century, and also between these veins and veins of the opposite side of a neck, unilateral occlusion internal I. it is usually quickly compensated century and never leads to heavy disturbances of blood circulation. The forecast in general is defined by a basic disease.

Treatment of thrombophlebitis I. carry out by anti-inflammatory drugs and antibiotics century. Infusions of a reopoli-glyukin with trental are at the same time shown, locally apply heparin, venorutonovy ointments or hirudoid. The forecast at timely treatment, as a rule, favorable.

Damages I. century — see Blood vessels. At damage outside I. century it can be alloyed, without being afraid of development of any complications. At damage internal I. century integrity it is recovered by an angiorrhaphy (see) or as necessary resect a part of a vessel and impose an anastomosis the end in the end. Broad mobilization of a vein is necessary for performance of such intervention. The patient shall be in situation with most given head; the anastomosis is imposed monofilny thread on an atraumatic needle. The forecast after technically correctly executed operative measures on I. there is usually good century.

See also Blood vessels. Bibliography: Vishnevsky A. S. and

Maksimenkov A. N. Atlas of peripheral nervous and venous systems, M., 1949; The Debt o-S and at r about in B. A.

An anastomosis and ways of roundabout blood circulation at the person, L., 1956; Pokrovsky A. V. Clinical angiology, M., 1979; Romankevich V. M. Distinctions of a structure of outside jugular veins, Saturday. nauch. works Bashkirsk. medical in-that, t. 11, page 107, Ufa, 1959; Tikhomirov of M. A. Varyanta of arteries and veins of a human body in connection with morphology of circulatory vascular system, Kiev, 1900; Specialty surgery of heart troubles and vessels, under the editorship of V. I. Burakovsky and

S. A. Kolesnikov, M., 1967; Venous problems, ed. by J. J. Bergan a. J. S. T. Yao, Chicago — L., 1978.

A. V. Pokrovsky (pathology), M. P. Sapin

(An.).

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