Internal Jugular Vein Thrombosis

Etiology

Hypercoagulable States (see Hypercoagulable States)

Infection

Neoplasm

Surgery/Iatrogenic

  • Surgical Neck Dissection
  • Jugular Bulb Catheter
  • Neck Surgery with Prolonged Internal Jugular Vein Retraction: due to stasis in the internal jugular vein
  • Internal Jugular Central Venous Catheter/Swan-Ganz Catheter (see Central Venous Catheter): due to local vascular damage or stasis in the internal jugular vein
  • Subclavian Vein Central Venous Catheter/Swan-Ganz Catheter (see Central Venous Catheter): due stasis in the internal jugular vein

Other

  • Idiopathic
  • Internal Jugular IV Drug Abuse: due to local vascular damage to internal jugular vein
  • Neck Massage
  • Trauma
  • Gonadotropin Induction of Ovulation

Diagnosis

  • Contrast Neck CT: may be the procedure of choice
    • Low-density thrombus within internal jugular vein
    • Sharply defined bright internal jugular vessel wall (due to contrast uptake by the vasa vasorum)
    • Soft tissue swelling surrounding the internal jugular vein
    • Distended internal jugular vein just proximal to the thrombus
  • Doppler U/S of Neck Veins: usually diagnostic
  • Venogram: not usually necessary
  • Neck MRI: may be useful

Clinical

  • Pain Over IJ Site: variable

Treatment

  • Catheter-Related Cases: remove catheter at the first opportunity
  • Lemierre’s Syndrome-Related Cases: see Lemierre’s Syndrome, [[Lemierres Syndrome]])
  • Catheter-Directed Thrombolysis: may be indicated for some cases with associated sigmoid sinus thrombosis
  • Anticoagulation
    • However, rates of pulmonary embolism from isolated internal jugular vein thrombosis are low
      • Rate of pulmonary embolism for isolated subclavian/axillary vein thrombosis: 4% [MEDLINE]
      • Rate of pulmonary embolism for isolated internal jugular vein thrombosis: 0.5% [MEDLINE]
      • Rate of pulmonary embolism for combined subclavian/axillary vein + internal jugular vein thromboses: 2.4% [MEDLINE]
  • Superior Vena Cava (SVC) Filter: rarely required for internal jugular vein thrombosis alone (although may be required in some cases with coexisting axillary/subclavian vein thromboses)

References

  • Acute upper extremity deep venous thrombosis: safety and effectiveness of superior vena caval filters. Radiology. Jan 1999;210(1):53-8 [MEDLINE]
  • Morbidity and mortality associated with internal jugular vein thromboses. Vasc Endovascular Surg. Jul-Aug 2005;39(4):335-9 [MEDLINE]
  • Sigmoid sinus thrombosis associated with internal jugular venous occlusion: direct thrombolytic treatment. J Endovasc Surg. Aug 1996;3(3):306-14 [MEDLINE]
  • Internal jugular vein thrombosis associated with hemodialysis catheters. Radiology. Sep 2003;228(3):697-700 [MEDLINE]