A rare case of spontaneous bilateral internal jugular vein (IJV) thrombosis is presented in absence of oral infection, malignancy, or intervention. Swelling of face, neck, and both upper limbs developed in a 30-year-old man 1 month before admission and after 4 weeks of use of nonpadded crutches. Computed tomography of the neck showed thrombus occluding both internal jugular veins extending to the opening of the superior vena cava. Protein S activity was found to be 30.3%, less than half of the lower limit of normal. Fibrinogen was 450 mg%, higher than normal. Protein C and antithrombin III were normal. The patient was treated conservatively, and discharged on aspirin 150 mg/day. Follow-up after 3 months showed no complications. It was concluded that the outcome in IJV thrombosis, caused by protein S deficiency, is usually good. The advantage of being aware of diagnosis is that physician can be more vigilant for potential complications and treat them earlier.
Paragangliomas(PGL) are rare tumours that arise from extra-adrenal paraganglia. Extra-adrenal paragangliomas account for only 5 to 10% of all paragangliomas and may present incidentally as a mass. Typical triad of fluctuating hypertension, headache, and sweating is not always present which makes the diagnosis sometimes difficult. Extraadrenal retroperitoneal PGLs are functionally active more often than previously reported and that they are readily detected by soft tissue masses closely associated with the entire length of abdominal aorta. However, no CT feature was found that was unique for PGL.1 Herein we describe the clinical, radiological and pathological features in young patient presented for hypertension and paraparesis, and later on diagnosed as malignant abdominal paraganglioma with vertebral and lymph node metastasis.
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