Sonographic measurement criteria for the diagnosis of internal jugular phlebectasia in children

BACKGROUND: To establish sonographic (US) criteria for the diagnosis of internal jugular phlebectasia (IJP) in children and to determine reliable cutoff values of US measurements with high specificity and sensitivity. METHODS: We used B-mode US for the measurement of internal jugular vein transverse (T) and anteroposterior (AP) diameter, and cross-sectional area (CSA) at rest and during the Valsalva maneuver (VM) in 21 patients, aged 15 months to 16 years, diagnosed with IJP, and compared the results with those of 88 healthy children. Receiver operating characteristics curves were used to determine the optimal cutoff values. RESULTS: Patients with IJP had higher T, AP diameters, and CSA at rest and during VM than controls on the same side (p < 0.001). Receiver operating characteristics curves showed that CSA during the VM on both sides yielded the best results (cutoff value 220 mm(2) with 92.3% sensitivity, 92% specificity on the right side; 188 mm(2) with 90% sensitivity, 87.5% specificity on the left side). AP diameter offered better specificity and sensitivity (≥85%) than T diameter during VM on both sides. CONCLUSIONS: We suggest using an AP diameter >15 mm as a cutoff point for both sides for the diagnosis of IJP in daily practice. US measurement of the jugular vein diameter might help increasing clinicians' awareness of clinically unrecognized cases of IJP and identifying borderline cases that require follow-up.