The test results my wife got at BNAC identified a flap in her left IJV. In the doppler image
they noted the flap and a valve. I"m not clear what problems this flap might cause.
Is it part of a malformed valve? Have you encountered flaps in your CCSVI treatments and what is their significance?
Thanks for the education you are providing to make us better patients and partners with doctors.
my wife (Ozarkcanoer) last week had doppler and MR exam at BNAC. Their report to us was that she has a 7.7 mm long stenosis in her right IJV resulting in nearly absent flow and there was a negative delta CSA in the right IJV, also that they saw a flap in her left IJV. So they detected two of five ECD-TCCS criteria. You can see three images I've posted in TIMS at http://www.thisisms.com/ftopic-11810-30.html
The iron analysis showed her with higher iron present for her age (64) than the other MS patients and healthy controls they have tested.
I'm unclear what pathology the flap indicates in her left IJV, and why there would be no reflux detected with the stenosis present in the right IJV. Would you comment?
We are going to see a St. Louis MO, Barnes Hospital/Washington U. Medical School professor and neuroradiologist next week to consult on these results; not confident he'll be willing to do venography and treatment but it's our next step.
thank you for all the education and interaction you take the time to do on this forum.
The list of findings that i wrote on this site was my attempt to standardize nomenclature of the pathological entities that we see. Unfortunately i lost traction by being put on the shelf, but i will continue to describe these findings and hope that all investigators and practicioners can agree at some time to standardization.
in the meantime i have to guess what they meant by a flap.
a flap may represent a thin linear filling defect. if it were parallel to the wall, i would call it a septum, if it were perpedicular to the wall, i would call it a web. It appears that both cause outflow resistance.
i imagine that a web is really a valve leaflet that may be like the lid of a trashcan. depending upon circumstances it might cause terrible flow limitation, but a catheter can push it out of the way and lead to a missed diagnosis. I have found one that was really thin, almost imperceptible and seen on only one of four views. The other was really thick and shocking in its appearance. The part that was attached to the wall was like a pinky jutting into the lumen of the blood vessel. Angioplasty may or may not work. I just do not have sufficient long term experience to know yet.
I imagine a septum as a double barrel blood vessel. the ones that i have seen are right at the confluens with the subclavian vein. They were really difficult to recognize on venography because they are superimposed on each other and tend to blur into each other. Before I recognized this on the IVUS, i saw it on the venogram, but didnt realize what a problem it was. It is most easily recognized by IVUS. In the cases i have seen one of the two barrels was always blind ending and cause compression of the true vein. I have fount three. one clotted off the good vein on angioplasty (my first case). the other two were treated and I await followup. The third i picked up only on IVUS.
After posting this, i found your wife's MRvenogram. it showed what i would call a septum, dividing the vein in two. However i would call this an inomplete duplication of the jugular vein.
in fact is suspect that those images have a duplication on each side