0:01

We've put a lot of emphasis on the involvement of the

0:05

carotid artery by tumor,

0:07

and whether or not it's going to be salvageable.

0:10

Why are we not concerned about the jugular vein?

0:13

Well, as most people know,

0:14

when one does a radical neck dissection for tumor,

0:19

there is removal of the jugular vein.

0:22

That's one of the components of the neck dissection,

0:25

because there is a high rate of infiltration.

0:29

This is a patient who has a thyroid cancer.

0:31

Now, thyroid cancers are generally not treated surgically.

0:35

They're usually treated with I-131

0:38

radiation or radiation therapy,

0:41

but you can do a total thyroidectomy as well.

0:44

In this case,

0:45

what was unusual about this thyroid cancer was that

0:49

there was invasion into the jugular vein

0:53

with this intermediate density tissue that you see.

0:58

Here you can see the thyroid cancer invading the wall

1:02

of the jugular vein and growing into it.

1:05

So most of the time we see involvement around the

1:08

circumference of a carotid sheath vessel,

1:11

not true infiltration through the wall.

1:13

But this was relatively striking and was confirmed

1:17

at surgery. Look at this on the coronal image.

1:20

It's really quite a beautiful case because you can see

1:24

the lateral extension and growth of the thyroid cancer

1:30

primary tumor, not a metastasis,

1:32

but the primary tumor is growing into the jugular vein.

1:38

It is so beautiful.

1:39

So let's look at it on sagittal imaging as well.

1:42

Nothing like multiplanar imaging.

1:45

And here we can see the primary tumor.

1:48

We see the carotid artery.

1:50

Here you see the growth from the thyroid gland,

1:54

through the wall of the jugular vein with

1:58

tumor in the jugular vein.

2:01

And the risk here is of further metastasis and

2:07

growth into the superior vena cava and potentially even

2:13

pulmonary metastases on an embolic phenomenon.

2:17

So, pretty outstanding and interesting case of direct

2:22

invasion of the wall of the jugular

2:24

vein by a thyroid cancer.