Etiology
Hypercoagulable States (see Hypercoagulable States)
- Hyperhomocysteinemia (see Hyperhomocysteinemia)
- Polycythemia Vera (see Polycythemia Vera)
Infection
- Lemierre’s Syndrome (see Lemierre’s Syndrome)
- Deep Neck Infection (see Deep Neck Infection)
- Necrotizing Soft Tissue Infection
Neoplasm
- Head and Neck Cancer (see Head and Neck Cancer)
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
- 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]