AlmostClever MRV Pics: What do you think?

AlmostClever · Post by **AlmostClever** » Tue May 25, 2010 7:46 am

Hi all!

Just fig'd ot how to upload these from my MRV yesterday!

First pic is anterior, second is posterior.(I think!)

1) Looks like the left external jug vein is obstructed?
2) Vertebral veins - heavy collateral activity!?

(Also, should these even be active while lying down? I'm thinking blood is seeking the path of least resistance and drains out of the vert's even while laying down because of blocked jug. Sound plausible?

Thanks for yor input/observations!!!

A/C

mangio · Post by **mangio** » Tue May 25, 2010 10:11 am

Congrats.

AlmostClever · Post by **AlmostClever** » Tue May 25, 2010 3:20 pm

Thanks mangio!

Is it possible that the veins with collaterals (center) might be anterior jugulars and not vertebrals?

Johnson · Post by **Johnson** » Tue May 25, 2010 4:32 pm

AlmostClever wrote:Thanks mangio!

Is it possible that the veins with collaterals (center) might be anterior jugulars and not vertebrals?

Not being a sonographer, or a doctor, I throw my impression out as a layman.

Those are probably not the best pics, and you will likely find better ones in the MRV folder. The collateral veins in the centre are - I think - coming off your thyroid, which is just below your larynx. I do not think they are vertebrals. There appears to be a massive collateral from the R IJV (on the left of top image), and there is that weird vessel spiraling up and around the IJV. That looks to be related to the stenosis.

I'm sure that a real medico would want to look at quite a few more pics before commenting.

If you look at my post on the tracking thread, you will see my pics, and spot the difference in picture quality. It would be great to see any pictures that show the head and neck.

AlmostClever · Post by **AlmostClever** » Tue May 25, 2010 5:26 pm

Johnson wrote:
Those are probably not the best pics, and you will likely find better ones in the MRV folder. The collateral veins in the centre are - I think - coming off your thyroid, which is just below your larynx. I do not think they are vertebrals. There appears to be a massive collateral from the R IJV (on the left of top image), and there is that weird vessel spiraling up and around the IJV. That looks to be related to the stenosis.

I'm sure that a real medico would want to look at quite a few more pics before commenting.

If you look at my post on the tracking thread, you will see my pics, and spot the difference in picture quality. It would be great to see any pictures that show the head and neck.

Thx Johnson,

I agree - those pics are terrible! I had to swallow alot while I was in the tube and I think the techs were in a hurry to go home! At least I think the pics show some issues and can get me to the next level...

Still trying to interpret doppler, but your labels helped alot! I definately have reflux!!!

A/C

AlmostClever · Post by **AlmostClever** » Wed May 26, 2010 11:53 am

Test report in:

"FINDINGS: This was tried to be done as a venogram. There is no obvious occlusion of the jugular veins.

IMPRESSION: "Grossly unremarkable study"

NOTE: For venous evaluation a CT angio should be ordered."

This is from a radiologist with over 25 yrs experience! Hmm.. I think he is a little arrogant and didn't even bother looking at the images!

I'll post the Ax 2DTOF that shows my left external jug disappearing altogether as well as my right IJV being small! plus my left IJV "folding" in on itself!

Unbelievable...

Trish317 · Post by **Trish317** » Wed May 26, 2010 12:16 pm

AlmostClever wrote:Test report in:

"FINDINGS: This was tried to be done as a venogram. There is no obvious occlusion of the jugular veins.

IMPRESSION: "Grossly unremarkable study"

NOTE: For venous evaluation a CT angio should be ordered."

This is from a radiologist with over 25 yrs experience! Hmm.. I think he is a little arrogant and didn't even bother looking at the images!

I'll post the Ax 2DTOF that shows my left external jug disappearing altogether as well as my right IJV going from 12 mm to under 6 mm! plus my left IJV "folding" in on itself!

Unbelievable...

It says that it was attempted to be done as a "venogram". Isn't a venogram the "invasive" procedure? Maybe I'm wrong. I'm still learning and trying to remember everything.

But isn't it a positive that it says a CT angio should be ordered?

AlmostClever · Post by **AlmostClever** » Wed May 26, 2010 1:31 pm

Trish317 wrote:
It says that it was attempted to be done as a "venogram". Isn't a venogram the "invasive" procedure? Maybe I'm wrong. I'm still learning and trying to remember everything.

But isn't it a positive that it says a CT angio should be ordered?

I think the invasive venogram is called "catheter venography".

Is kind of positive that he recommends the CT, but I think he could have at least made some comments about the spaghetti in my head! I spent 8 hours that day to get this done and feel I deserve a little more than "unremarkable" when clearly something is amiss!

I plan to live longer than the time it takes the radiation to get me and prefer not to do CT scans!

Anyways, here are some of my 2D TOF images with comments starting higher up and going down the head/neck.

Is my right IJV getting squished here?

Can clearly see the left external jugular here...look how small the right jug is compared to the left!

Oops! Where's my left external jug going? Is that my left IJV or Pac-Man?

Chomp! Game over!

Got a 3-slot appt with the ol' GP Friday afternoon to look at these... he might see what I see...maybe!

AlmostClever · Post by **AlmostClever** » Wed May 26, 2010 3:47 pm

Trish317 wrote:
AlmostClever wrote:Test report in:

"FINDINGS: This was tried to be done as a venogram. There is no obvious occlusion of the jugular veins.

IMPRESSION: "Grossly unremarkable study"

NOTE: For venous evaluation a CT angio should be ordered."

This is from a radiologist with over 25 yrs experience! Hmm.. I think he is a little arrogant and didn't even bother looking at the images!

I'll post the Ax 2DTOF that shows my left external jug disappearing altogether as well as my right IJV going from 12 mm to under 6 mm! plus my left IJV "folding" in on itself!

Unbelievable...
It says that it was attempted to be done as a "venogram". Isn't a venogram the "invasive" procedure? Maybe I'm wrong. I'm still learning and trying to remember everything.

Trish: I believe you were right! Just shows you what a ding-dong that radiologist is!

AlmostClever · Post by **AlmostClever** » Thu May 27, 2010 8:46 am

Just got off the phone with a radiologist and wanted to share this info so that someone else can avoid the frustration I have had with this.

Here is what I was told:

MRV's are not good for this type of study!

"Pulsatile flow" in the veins can cause the "stair-stepping" disruption of the image you see in my 3-d pictures.

It can also result in the "pac-man" I comment on in my 2d TOF pictures.

So - it's back to sqare one! I will ask for the venogram and if I can't get that, I will do the CT (which the radiologist did recommend for this) although I'm not crazy about it.

Other than that, waiting on the New York phone call!

Have a nice weekend!

A/C