An anterior jugular vein variant in a patient requiring tracheostomy, demonstrating the importance of preoperative/procedural ultrasound.

A 50-year-old woman was admitted to the intensive care unit (ICU) for a life-threatening exacerbation of asthma requiring intubation and ventilation for 7 days. On day 8, she was stepped down from the ventilator via the insertion of a tracheostomy to aid weaning. It was initially decided that a percutaneous tracheostomy would be attempted on ICU, however, following further consideration, it was decided that due to anatomical factors (short neck) a surgical tracheostomy would be performed by the ear, nose and throat (ENT) team. A periprocedural USS was not performed. At surgery, instead of identifying two superficial anterior jugular veins lying on each side of the trachea, one large anterior jugular vein (median vein) was found overlying the entire anterior surface of the trachea. Had a PCT been attempted without an ultrasound scan being performed, this vessel would have been punctured, creating a significant bleed that could have placed the patient's airway and/or circulatory system at risk. 2016 BMJ Publishing Group Ltd.