Incidental Detection of Internal Jugular Vein Thrombosis Secondary to Undiagnosed Benign Substernal Goiter

Abstract

Internal jugular vein thrombosis is a serious event with potentially fatal outcome, where the clinical symptoms may be vague or absent. This paper refers to a rare case where routine carotid Doppler ultrasound prior to coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) in a 76-year-old man, incidentally revealed thrombosis of the right internal jugular vein. Thoracic CT demonstrated an underlying, large, benign substernal multinodular goiter, mainly involving the right lobe, causing compression and displacement of the great vessels. A successful, one-stage operation including ligation of the internal jugular vein to avoid pulmonary embolism and hemithyroidectomy, combined with the scheduled CABG and AVR, was performed. This case illustrates that benign substernal goiter may be associated with asymptomatic internal jugular vein thrombosis. Carotid Doppler ultrasound should involve evaluation of the internal jugular vein concerning thrombosis as its presence may reveal space-occupying lesions in the thorax.

Cerebral Venous Infarction due to Internal Jugular Vein Thrombosis: A Case Study and Review of Literature

“…Typically, patients with internal jugular vein thrombosis or obstruction present with transient facial oedema, with or without associated neck swelling. However, the majority of neck vein thrombosis present with subtle signs such as pain and swelling at the angle of the jaw [5,6]. e atypical presentation of internal jugular vein thrombosis in our patient has rendered the diagnosis difficult.…”

Large Substernal Thyroid Goiter Associated with Saddle Pulmonary Embolism

“…Upper extremity DVT and pulmonary emboli (PE) caused by substernal thyroid goiters are rare, with only a handful of reported cases in the literature. [1][2][3]5 One explanation for the infrequency of thyroid goiter-induced upper extremity DVT and PE is that their chronic and indolent growth pattern allows for the development of collateral circulation that helps prevent venous stasis, and thus, formation of DVT and pulmonary embolism. 2,4 Additionally, large substernal goiters are uncommon.…”

“…Substernal thyroid goiters have been linked to the formation of deep vein thrombosis (DVT). [1][2][3] As a substernal thyroid goiter enlarges, its mass effect can compress surrounding structures in the thoracic outlet. More specifically, the axillosubclavian and internal jugular veins can become compressed against the first rib, sternum, strap muscles, and thyroid goiter.…”

“…4 Venous stasis, coupled with endothelial injury from the mass effect, results in a thrombogenic condition. 3 Postural changes can temporarily decompress veins, enabling a thrombus to dislodge and travel into the pulmonary circulation. 5 This case report demonstrates the association of a large substernal thyroid goiter with an acute saddle pulmonary embolus.…”

Mediastinal B-Cell Lymphoma Presenting with Jugular-Subclavian Deep Vein Thrombosis as the First Presentation

“…Ghatak et al presented a case of spontaneous pulmonary embolism, IJVT, and subclavian vein thrombosis in a patient with septic shock who was found to have factor V Leiden mutation and activated protein C resistance and was curiously reported to have dengue IgM positive [ 14 ]. Lønnebakken et al found an internal jugular vein thrombosis incidentally secondary to substernal goiter [ 15 ].…”