Bilateral duplicated internal jugular veins: case study and literature review

A rare bilateral duplication of the internal jugular vein (IJV) was discovered during cadaveric dissection. From each jugular foramen, a single IJV descended to the level of the hyoid bone then divided into medial and lateral veins. The medial IJVs traveled in the carotid sheath; the lateral IJVs coursed posterolateral to the sheath across the lateral cervical region (posterior triangle) of the neck. On the right side, medial and lateral IJVs entered the subclavian vein separately. C2-C3 anterior rami and the suprascapular artery passed between the medial and lateral IJVs. The right external jugular vein passed aberrantly between the heads of the sternocleidomastoid muscle (SCM) into the subclavian vein anterior to the lateral IJV. On the left side, the medial IJV drained into a large bulbous jugulovertebrosubclavian (JVS) sinus that received six main vessels. The lateral IJV diverged posterolaterally toward the border of the trapezius muscle, received the transverse cervical vein, and then turned sharply anteromedially to drain into the JVS sinus. The lateral IJV also gave an aberrant additional large vein that passed laterally around the omohyoid muscle before entering the JVS sinus. The left external jugular vein paralleled the anterior border of SCM before passing posterolaterally to terminate in the JVS sinus. Jugular vein anomalies of this magnitude are very rare. Determining the frequency of multiple IJVs is hampered by inconsistent terminology. We suggest that IJV duplication differs from fenestration anatomically and, potentially, developmentally. Criteria for characterizing IJV duplication and fenestration are proposed. The mechanism of development and the clinical significance of multiple IJVs are discussed.