Asymmetrical or heterogeneous enhancement of the internal jugular veins in contrast-enhanced CT of the head and neck

With faster CT scanners, asymmetric/heterogeneous enhancement (ASHE) of the internal jugular veins (IJVs) is frequently encountered in the absence of pathology. We investigated the frequency, side, pattern and significance of ASHE in 200 patients with various head and neck lesions. Nonionic contrast medium (300 mgI/ml) was infused into a forearm vein (right, n=100); left, n=100). Forty seconds after contrast medium injection, contiguous 5-mm-thick sections were obtained craniocaudally from the skull base to the aortic arch. CT machines with two different scanning cycle times (3 s, n=100; 2 s, n=100) were used. ASHE of the IJVs was observed in 51 patients (25.5%); the patient group receiving a right-sided injection with a 2-s scan cycle machine, showing a higher frequency (44%). ASHE was divided into four patterns: homogeneous low density, focal low density, heterogeneous opacification and fluid-fluid level formation. ASHE was frequently observed in routine contrast-enhanced CT of the head and neck. Frequency of ASHE increased when the scanning cycle was shorter. We should be aware of this phenomenon to avoid its misinterpretation as venous thrombosis or other pathology.