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Jugular vein distention
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Jugular vein distention

Question

2 Years ago I was lifting wts pretty heavily (incline bench) I pushed hard that day, and when I was done I felt, a sharp pain in my chest that got my attention, and then shortly thereafter another. For weeks I wasn't really myself, I was tired all the time and it took me a long time to get back to "normal" (6 to 8 weeks). About a month after the incident I noticed a lump in my neck, about an inch below my adams apple. It was soft, about an inch in diameter and it would stick out about ½ inch with any type of ValSalva maneuver. I'm sure that I've never seen it before. Not quite feeling well, I first went to the Dr. in late May and they put me on antibiotics as they thought that I had "bronchitis" (No CXR, slight fever, normal HR). By the end of July I went back and they worked me up for thyroid with Thyroid Ultrasound (normal)  and bloodwork (normal). All came back normal. I was beginning to notice a substantial cough, from irritation of my trachea. Finally, I requested a CXR (I was afraid I had an aortic aneurysm or something, with the mechanism of injury, wheezing etc. I was a wreck), and they also ordered a CT with contrast. It showed that I had the following: CXR (2 Views, frontal and lateral) Cardiac silhouette, mediastinum, pulmonary vasculature and lung parenchyma are within normal limits without evidence of focal infiltrate, CHF or effusions. No significant hyperinflation or interstitial changes are appreciated. Impression: No acutedisease.
CT w/contrast This patient does have a very prominent branch of the external jugular which crosses the midline at the level of the thyroid gland and is responsible for this patient's mass. It is a benign venous branch arising from what appears to be a large external jugular. It is simply, however a tortuous collateral. No worrisome mass lesion is seen. I do not see any adenopathy on this examination. Submandibular and parotid glands are normal. Thyroid gland is normal. There does not appear to be significant plaque in the carotids. Superior mediastinum clear. Lung apices clear as well. Impression: This patient does have a venous tortuous collateral arising from the external jugular on the left which crosses the midline and would account for the midline mass. This is not a worrisome mass lesion and would probably have no clinical significance, but may vary in size relative to venous pressure.

That was the last testing that I had done. This EJV distension most definitely causes me some tracheal irritation/choking. Most of the opinions from my PCP and ENT are stating that they doubt that this is the cause. But I can reproduce the choking sensation by bending forward at the waste and increasing the size of the vessel. It's worsened with allergies as I drain a lot of post nasal fluid and it seems to irritate the same area.

Thanks any help is much appreciated.

Craig Burns



Do you think that if this was any type to clotting issue that it would have been revealed in a CT of the superior mediastinum? (Particularly the theory of some type of effort induced thrombus). Would an infarction of the R ventricle lead to such a sudden collateral formation, and venous distension? (unless it was present before and I just never noticed it). It was a very disconcerting period for me. After this happened I definitely had a period of markedly reduced endurance, for probably 6 to 8 weeks. I also had, what I percieved to be a very sharp pain, in the area of the Jugular that could be reproduced with any significant Val Salva type maneuver (eg. I was inflating a cushion, and the act of simply pushing down on the valve to hold it in place would reproduce this sharp pain the the area,....which would cease as soon as I let up). Anyway,...at this point I am symptom free. I walk 6 miles a day, and jog a couple of miles each night. (no more weight lifting). I still occasionally get the odd feeling of discomfort in the deep jugular area, although there is no corrolation with activity or movement anymore.
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You may want to research your questions with the board's archives. Has your doctor given an opinion regarding your condition? Without your medical  history, previous tests, changing symptoms, etc. etc. there is not an adequate perspective to the matter and calls for speculation.
Or you may post your question (in a clear, concise format) to a professional MD on the expert forum.  There usually are no follow up answers...only one bite of the apple...
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