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Portrait of Jugular vein

Anatomy · Heart & blood vessels

Jugular vein

Main venous drainage of the head and neck

Neck · carotid sheath and superficial neck

The jugular veins drain blood from the head and neck. The internal jugular vein, the larger, leaves the skull through the jugular foramen and runs down within the carotid sheath, lateral to the carotid artery, to join the subclavian vein and form the brachiocephalic vein. The external jugular vein runs superficially across sternocleidomastoid and is visible under the skin.

How to spot them

  • ▸Internal jugular: deep, in the carotid sheath, lateral to the common carotid artery; a continuation of the sigmoid sinus
  • ▸External jugular: superficial, crosses sternocleidomastoid obliquely and drains into the subclavian vein
  • ▸The internal jugular joins the subclavian vein behind the sternal end of the clavicle
  • ▸Anterior jugular veins run near the midline and drain into the external jugular or subclavian veins

What to know

Leaves the skull through a foramen shared with cranial nerves IX, X and XI, as the continuation of the sigmoid sinus

Jugular vein — the internal jugular begins at the jugular foramen.

Runs down the neck in the carotid sheath, lateral to the common carotid artery

Jugular vein — the internal jugular vein.

It joins the subclavian vein behind the sternal end of the clavicle to form the brachiocephalic vein

Jugular vein — the venous angle.

Its visible pulsation in the neck, measured from the sternal angle, indicates pressure in the right atrium

Jugular vein — the jugular venous pressure (JVP).

A superficial vein that can be seen crossing the sternocleidomastoid when someone coughs or strains

Jugular vein — the external jugular vein.

A common site for inserting a central venous catheter under ultrasound guidance, on the right side by preference

Jugular vein — internal jugular cannulation.

The thoracic duct on the left and the right lymphatic duct on the right empty at the junction where this vein meets the subclavian

Jugular vein — the jugulo-subclavian junction.

Key ideas

  • The JVP reflects right atrial pressure. A raised JVP suggests heart failure, fluid overload, tamponade or SVC obstruction.
  • Neck veins lie above the heart at low pressure, so air can be drawn in if a large one is opened, causing air embolism.

Quick-fire facts

  • •Internal jugular: from jugular foramen to the venous angle behind the medial end of the clavicle.
  • •It lies in the carotid sheath lateral to the common carotid artery, with the vagus nerve between and behind them.
  • •The external jugular is formed by the retromandibular vein (posterior division) and the posterior auricular vein near the angle of the mandible.
  • •External jugular drains into the subclavian vein.
  • •The right internal jugular is the preferred route for central lines: straight path to the right atrium.
  • •The word derives from Latin jugulum, 'throat' or 'collarbone', from jugum, 'yoke'.
  • •JVP is assessed with the patient at 45 degrees; normal is up to about 3–4 cm above the sternal angle.
  • •The thoracic duct joins the left venous angle; the right lymphatic duct joins the right.

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Sources