Analysis of a First Unilateral and Then Bilateral Internal Jugular Vein Thrombosis in a Heroin User

Abstract

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.

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“…Radiography or computed tomography is typically performed for detailed and appropriate treatment planning in such cases. Considering the growing role and advantages of ultrasonography (USG) in the diagnosis of oral and maxillofacial pathology 4,5 , especially in infection cases [6][7][8] , the application of USG seems to be preferable for the precise localization of pus in osteomyelitis cases.…”