Diagnosis of internal jugular vein thrombosis.

Abstract

Six patients, aged 14-83 years, were shown by computed tomography (CT) to have thromboses of the internal jugular vein. In all cases, medical attention was sought only after a delay (4-21 days). In no case was the provisional clinical diagnosis correct, with working diagnoses ranging from abscess to neoplasm. A wide variety of likely causes was discovered, including venous catheters, local malignancy, infective cervical adenopathy, and polycythemia. CT showed distended veins with enhancing walls, low-attenuation intraluminal filling defects, and swelling of the adjacent soft tissues. Four of the six patients also underwent ultrasound examinations, which showed the veins to be distended and nonpulsatile, with internal echoes. Both modalities proved reliable and accurate. Because of the subtle and often non-specific clinical findings, it is likely that more clinically unsuspected cases will be encountered by the radiologist.

Evidence Based Management of Spontaneous Internal Jugular Vein Thrombosis: A Literature Review

“…Doppler U/S is a sensitive and safe imaging technique with the ability to demonstrate the loss of respiratory rhythm within the vein which has been shown to be useful in both diagnosis and follow up [10]. However, U/S has been considered inferior to CT in several areas as a diagnostic tool [11]. Ultrasound does not have the capacity to visualize accurately the surrounding tissues and in most cases, initial U/S is often followed by a CT scan to obtain a more detailed imaging.…”

“…However, U/S is still used as initial imaging of choice due to low clinical suspicion of the disease in the initial setting, and the ease and availability of U/S in most departments [12]. Several previous articles [13][14][15][16] and a more recent article by Kale & Wight [5] have demonstrated the potential benefits of CT scanning in their patient cohort including speed and reliability. However, there are no recent notable studies evaluating the benefits of CT scanning in IJV thrombosis.…”

Lemierre Syndrome: Not So Forgotten!

“…Ultrasound examination may also provide a simple and inexpensive way for serial imaging to assess resolution after the initial diagnosis is established. 15 However, we recognize that not all physicians may have the training to diagnose thrombosis of the internal jugular vein by a bedside ultrasound examination, and we would recommend a formal ultrasound examination or contrast-enhanced CT until confirmatory reports or studies are performed.…”

Lemierre syndrome in a child with recent pharyngitis

“…Serial imaging studies may be necessary, and ultrasound is now recommended as the initial modality to evaluate for internal jugular thrombosis. 12,13 ED diagnosis and treatment is traditionally limited to a high clinical index of suspicion, early empiric antibiotic administration and subsequent imaging; however, emergency physicians skilled in ultrasound evaluation may be able to improve diagnostic performance and rapidly confirm Lemierre syndrome by identifying internal jugular thrombosis on rapid ED scans. 14 Initial treatment involves high-dose IV penicillin and metronidazole, or IV clindamycin monotherapy, with conversion to 2-6 weeks of oral therapy after the patient's clinical condition has stabilized.…”