Chronic internal jugular vein (IJV) thrombosis (> 10 days after acute event) where clot persists within lumen after soft tissue inflammation is gone

JV thrombophlebitis: Acute-subacute thrombosis of IJV with associated adjacent tissue inflammation

Acute thrombophlebitic phase

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  Loss of fascial planes between IJV & surrounding soft tissues + cellulitis

  
  
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  Echogenic intraluminal thrombus, distended, noncompressible IJV

  
  
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  Acute thrombus may be anechoic & difficult to distinguish from flowing blood; lack of compressibility & absent color or flow signal on Doppler may be only clues

  
  
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  Loss of venous pulsation & respiratory phasicity

  
  
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  No flow seen within echogenic venous thrombus

  
  
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  Tumor infiltration of IJV causes tumor thrombus with ↑ vascularity on Doppler US, most commonly from thyroid anaplastic carcinoma or follicular carcinoma

Chronic phase

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  Collateral veins may be detected

  
  
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  Central liquefaction or heterogeneity of thrombus

  
  
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  Thrombus tends to be well organized & echogenic

  
  
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  May be difficult to separate from perivascular echogenic tissues

  
  
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  Absence of phasicity in jugular or subclavian veins may suggest more central nonocclusive thrombus

Sluggish or turbulent flow in IJV (pseudothrombosis)

Suppurative lymphadenopathy, neck abscess

SCCa malignant lymphadenopathy

Scan neck in neutral flat supine position; if head is elevated, cerebral venous drainage occurs mainly via vertebral vein & IJV will be collapsed

Avoid over-rotation of head to contralateral side, as this may cause neck musculature to compress vein