Endocrine Abstracts

Introduction: Jugular vein agenesis is an extremely rare condition and its prevalence is not well-established. Case reports in the medical literature are limited, emphasizing the rarity of this anatomical variation.

Case Presentation: Agenesis of the jugular vein is a rare anatomical variation characterized by the congenital absence or significant underdevelopment of the jugular vein, an essential vascular structure in the venous drainage of the head and neck. Although rare, this condition can have notable clinical implications defying expectations in medical evaluation and surgical practice. We present the amazing case of a patient with agenesis of the right jugular vein and hypertrophy of the contralateral vein. In lateral cervical dissections, the internal jugular vein is a main anatomical reference to perform the procedure. This is a 60-year-old woman with a diagnosis of medullary thyroid carcinoma and a calcitonin of 331 pg/ml . After being presented to a multidisciplinary committee it was decided to perform Total Thyroidectomy associated with bilateral central and bilateral lateral cervical dissections\. During the approach to the left lateral compartments, a highly dilated internal jugular vein with a transverse diameter of more than 3 cm was observed. When approaching the right lateral compartments, the carotid sheath was completely released from the posterior belly of the digastric muscle to the clavicle, with identification of the carotid artery and vagus nerve without being able to identify the right internal jugular vein. Intraoperatively, the images of the preoperative studies were reviewed with the Radiology Department confirmed the absence of the right internal jugular vein. Finally, the procedure was completed without incident and the patient was discharged within 24 hours.

Discussion: The case of jugular vein agenesis highlights the uniqueness and complexity of anatomical variations in the vascular system. Although this condition is exceptional, its recognition is crucial for accurate clinical evaluation and appropriate management of affected patients. The absence of the jugular vein can complicate common surgical procedures, such as vascular access, and is of vital importance in those where it constitutes an anatomical reference or in locally advanced tumors that require vascular resection where if it is not taken into account, it can have disastrous consequences for the patient. Complete understanding of the patient’s specific anatomy and detailed planning are important elements in the success of the surgical intervention. Cervical endocrine surgery should be performed by experienced surgeons to identify possible anatomical variants and reduce the comorbidity of surgery.