Thrombosed Internal Jugular Vein

Epidemiology

In contrast to venous thrombosis in the lower limbs, thrombosis of the internal jugular vein is uncommon. This entity is usually seen in patients with a history of central venous line insertion, drug abuse, neck infection, previous neck irradiation, and systemic disease such as sepsis or malignancy.

Clinical Findings

Patients usually have an underlying disease. They may be asymptomatic or have neck swelling. The thrombus may become infected and result in a thrombophlebitis. These patients present with pain, tenderness, erythema, and sometimes fever. On palpation, the thrombosed vein resembles a thick tubular structure. In the chronic phase, the thrombosed vein resembles a hard cord.

Pathology

In the neck, an indwelling catheter may cause damage to the vessel wall thus inducing platelet aggregation. Strands of fibrin are deposited trapping both red and white blood cells. Thrombosis may proceed to total internal jugular vein thrombosis. The thrombus thus formed is usually very adherent to the inflamed vessel wall. There is therefore a very low risk of thromboembolism. However, thrombosis induced by bacterial infection is prone to dis-integrate, resulting in septic thromboembolism

Treatment

Treatment is directed at removing the underlying cause of the thrombosis. Sepsis should be treated and the indwelling catheter, if present, removed. Anticoagulation therapy may also be started depending on the cause of thrombosis.