Idiopathic Bilateral External Jugular Vein Thrombosis

Abstract

Patient: Male, 21Final Diagnosis: Idiopathic bilateral external jugular vein thrombosisSymptoms: Face engorgement • neck swellingMedication: —Clinical Procedure: NoneSpecialty: HematologyObjective:Unknown ethiologyBackground:Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow’s triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood resides there and flows against gravity. The veins of the lower extremities are dependent on intact valves and fully functional leg muscles. However, in case of valvular incompetency or muscular weakness, thrombosis and blood stasis will occur as a result. In contrast, the veins of the neck, specially the jugulars, have distensible walls which allow flexibility during respiration. In addition, the blood directly flows downward towards the heart. Nevertheless, many case reports mentioned the thrombosis of internal jugular veins and external jugular veins with identified risk factors. Jugular vein thrombosis has previously been associated in the literature with a variety of medical conditions, including malignancy.Case Report:This report is of a case of idiopathic bilateral external jugular vein thrombosis in a 21 year-old male construction worker of Southeast Asian origin with no previous medical history who presented with bilateral facial puffiness of gradual onset over 1 month. Doppler ultrasound and computed tomography were used in the diagnosis. Further work-up showed no evidence of infection or neoplasia. The patient was eventually discharged on warfarin. The patient was assessed after 6 months and his symptoms had resolved completely.Conclusions:Bilateral idiopathic external jugular veins thrombosis is extremely rare and can be an indicator of early malignancy or hidden infection. While previous reports in the literature have associated jugular vein thrombosis with malignancy, the present case shows that external jugular vein thrombosis can also be found in persons without malignancy.

Bilateral internal jugular vein thrombosis due to malignant tumor

“…Increasing age, obesity, and associated illness have also been attributed as causes. External compression over the vein has also been reported as a possible cause [1, 4, 6–9]. …”

“…Due to the increased risk of further potentially life-threatening thrombotic episodes, such as the risk of PE, patients with a thrombosed IJV often receive anticoagulation [4, 5, 9, 10]. …”

“…However, in the presence of septic emboli or with clear evidence of clot propagation, many physicians choose to add systemic anticoagulation, as in our patients [4, 8–10]. …”

“…Ultrasonographic findings include a dilated and incompressible vein, intraluminal clot (a late finding), and no response to the Valsalva maneuver (expected change in intraluminal volume secondary to enhanced venous return) [2, 4, 6, 8]. …”

“…Sometimes, if needed, a superior cava vein filter can be used to prevent pulmonary embolism (PE). Although surgical intervention is rarely necessary, infected thrombophlebithis, associated with a deep neck infection, calls for drainage of any fluid collection and debridement of all infected tissue [4, 5, 7]. …”