ANATOMIC VARIATIONS Three superficial veins coursing over the clavicles: a case report Nikolaos Anastasopoulos • George Paraskevas • Stylianos Apostolidis • Konstantinos Natsis Received: 15 May 2014 / Accepted: 10 February 2015 Ó Springer-Verlag France 2015 Abstract We report a unique bilateral combination of multiple variations in the superficial venous system of the neck of a 77-year-old male cadaver. On the right side of the neck, the external jugular vein (EJV) crossed superficial to the lateral third of the clavicle constituting a common trunk with the cephalic vein (CV) that drained into the subclavian vein (SCV). On the left side the EJV descended distally, passed over the anterior surface of the medial third of the clavicle and drained into the SCV. The posterior external jugular vein (PEJV) crossed superficial to the lateral third of the clavicle and terminated into the CV, providing an additional communicating branch to the EJV. Knowledge of both normal and abnormal anatomy of the veins of the neck plays an important role for anesthesiologists or car- diologists doing catheterization, orthopedic surgeons treating clavicle fractures and general surgeons performing head and neck surgery, to avoid inadvertent injury to these vascular structures. Keywords Anatomic variations Á External jugular vein Á Posterior external jugular vein Á Cephalic vein Introduction The external jugular vein (EJV), as part of the superficial neck vein system, collects most of the blood from the scalp and deep part of the face, whereas the cephalic vein (CV) along with the basilic veins drain most of the blood of the hand, as well as the subcutaneous tissue of the entire upper limb [10]. The EJV is formed by the union of the posterior division of the retromandibular and posterior auricular veins, just below or within the parotid gland. The EJV crosses obliquely, superficial to the sternocleidomastoid muscle, is covered by platysma, crosses the transverse cervical nerve and runs parallel with the auricular nerve. Normally the EJV just above the midpoint of the clavicle pierces the deep cervical fascia, usually joining the sub- clavian vein (SCV), in an incidence of approximately 56.4 %, while in 30.8 % of cases the EJV ends in the in- ternal jugular vein (IJV) and in 6.2 % of cases it finishes in both veins, SCV and IJV [3]. The CV runs through the deltopectoral triangle to drain into the axillary vein, just distal to clavicle [20]. The posterior external jugular vein (PEJV) begins in the occipital scalp, drains the skin and the superficial muscles of the posterosuperior part of the neck and usually joins the middle part of the EJV [20]. Varia- tions in the origin and termination of superficial veins of the neck are numerous and well documented [3, 11, 14]. The EJV, as one of the variable veins, demonstrates vari- ability regarding its tributaries [6], showing more varia- tions at its origin than its end [3]. On the contrary, the CV displays a high variability concerning its termination site. Thus, it could drain into the EJV, the IJV, the SCV or the basilic vein [9, 19]. Nevertheless the presence of the EJV and the PEJV passing over the clavicle is a notable variation [2]. We pre- sent a unique case of a bilateral EJV running superficial to the clavicle and a unilateral PEJV coursing over the lateral third of the clavicle, in one person. The knowledge of such com- bination of anatomic variations could be helpful to physi- cians to reduce the hazards of inadvertent iatrogenic injuries and prevent postoperative complications. N. Anastasopoulos Á G. Paraskevas Á S. Apostolidis Á K. Natsis (&) Department of Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, P.O. Box 300, 54124 Thessaloniki, Greece e-mail: natsis@med.auth.gr 123 Surg Radiol Anat DOI 10.1007/s00276-015-1445-4