This report documents a first unilateral and then bilateral internal jugular vein (IJV) thrombosis as a result of repeated injections of heroin, which is rare in a practice of oral and maxillofacial surgeon. The patient was a 21-year-old male who was referred to a hospital with the diagnosis of phlegmon of the right neck. Emergency non-contrast computed tomography (5 images and 1 Supplemental Video are presented) revealed a hyperattenuating content in the lumen of expanded right IJV which fills its entire length. The patient received initial treatment according to the protocol. Ultrasound (US) (2 images and 2 Supplemental Videos are presented) in a first 24 hours supported the diagnosis describing a case as occlusive acute thrombosis. After 4 days of a positive dynamic the patient was transferred to outpatient mode. In a 10 day US examination (2 images and 2 Supplemental Videos are presented) simultaneously with positive changes in the lumen of a right IJV (partial clot lysis) an appearance of a left IJV thrombosis was noted. Analysis of thrombotic conditions of the neck, diagnostics methods, treatment options, and complications are performed.
The article presents a clinical case of nodular uterine leiomyoma of giant size on the background of type 2 diabetes mellitus, chronic hypertension and obesity with a classic picture of metabolic syndrome and the development of severe vascular pathology with steno-occlusive atherosclerotic lesions of the abdominal aorta bifurcation (Lerich’s syndrome) and acute circulatory disorders in the left lower extremity with gangrene of the toes of the left foot. The patient was hospitalized and comprehensively examined in the Department of Vascular Surgery of the Kyiv Regional Clinical Hospital (KRCH), which is the clinical base of the Department of Obstetrics and Gynecology №1 of the Shupyk National Healthcare University of Ukraine. The diagnosis was confirmed in the department and simultaneous two-stage surgery was successfully performed by gynecologists and vascular surgeons: first stage – pangysterectomy with revision of the abdominal organs and access to the abdominal aorta, second stage – thrombendarterectomy of the bifurcation of the abdominal aorta. In the postoperative period we restored peripheral blood flow, performed complete regression of ischemia, necrosis of the toes of the left foot dry, limited with a tendency to delimitation. Amputation of the first and second toes of the left foot was performed. Postoperative period was uneventful, on day 9 the patient was discharged home in satisfactory condition for further outpatient treatment. Diabetes mellitus type 2, chronic hypertension and obesity with a classic clinical picture of metabolic syndrome have led to the development of uterine leiomyoma and atherosclerotic changes in the abdominal aorta and main vessels of the lower extremities (Lerich’s syndrome). The successful outcome of this clinical case was made possible by the coordinated work of a multidisciplinary team of KRCH specialists both at the stage of comprehensive examination and diagnosis, and during simultaneous surgery.
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