Use of intravenous injection of agitated saline for the ultrasonographic diagnosis of total jugular vein occlusion

"Jugular vein is the most common site for venous thrombosis in the horse, usually secondary to intravenous. injections or catheterization, although thrombosis and thrombophlebitis can occur in the absence of preexisting vascular trauma. The thrombus may occlude the lumen of the vein, resulting in perivenous and. facial edema and dilatation of facial veins on the affected side, proximal to the thrombus. Ultrasonographic. diagnosis is useful in detecting type and progression of thrombosis, and its characterization as well as . aiding in surgical planning. Nevertheless bidimensional and Doppler evaluation is often complicated and. very operator dependant. The aim of this work is to test agitated‐saline contrast ultrasound for evaluating. permeability and evolution in a case of jugular thrombosis.. A 5 y old gelding brown was presented with dilatation of right side facial veins. The right jugular vein could. be palpated as thick, solid structures in the jugular groove. No manual congestion could be achieved. A. wide range linear 4‐11 MHz vascular transducer was used to scan both jugular veins. Bidimensional ultrasonography of the affected vein showed a homogeneous hypoecoic thrombus occluding a narrowed. right jugular vein for about 30 cm of length in the proximal and mid portion of the neck. Afterwards, 40 ml. of 0,9% NaCl solution were agitated back and forth between two syringes connected at right angles by a. three‐way stopcock. A 20G intravenous catheter attached to the three way via a flexible extension tube was placed in the right congestive facial vein.. During injection of agitated saline the transducer was positioned in two acoustic windows: the first on right. jugular vein, just caudal to the thrombus, the second on left jugular vein, immediately proximal to the thoracic inlet. A 30 s cineloop was then recorded in each acoustic window after the injection of each single. bolus.. No microbubbles were retrieved in the right jugular vein, beyond the thrombus, after injection of the first. bolus of agitated saline. Microbubbles were visualized in the left jugular vein as a small, intense echo signal. within the vein lumen after injection of the second bolus, demonstrating the presence of collateral vein circulation.. The absence of microbubbles beyond the jugular thrombus makes injection of agitated saline in facial veins. a candidate as an adjuvant technique for the diagnosis of total jugular vein occlusion. Although further studies including more cases are needed, this easy technique could serve as a good tool in collateral circulation detections and in decision making in this pathology."