Internal jugular vein thrombosis in a warfarinised patient: a case report

Abstract

IntroductionInternal jugular vein thrombosis (IJVT) is a rare but potentially fatal condition. It usually arises following trauma to the internal jugular vein but is also seen in association with coagulopathies and advanced malignancies as part of a para-neoplastic syndrome.Case presentationWe report a case of a 44 year old woman with a strong past medical history and family history of thrombotic disease who presented with abdominal pain and ascites. A stage III ovarian carcinoma was diagnosed and she underwent debulking of the tumour. She sustained a peri-operative haemorrhage and required insertion of a central line into the right internal jugular vein. At one month follow-up she presented as an emergency with a left neck mass and painful swallowing. A duplex ultrasound of her neck identified a left IJVT to the level of the brachiocephalic vein which had occurred despite warfarinisation and an INR of greater than 2. She was commenced on intravenous heparin and the swelling resolved over the course of a week.ConclusionThis case illustrates an unusual presentation of a rare condition. In this case, the precise aetiology is unclear as the IJVT may have been related to a coagulopathy or the presence of advanced malignancy and occurred despite adequate anticoagulation.

Clinical Significance of an Unusual Variation: Anomalous additional belly of the sternothyroid muscle

“…11,12,14−16 Compression of the IJ vein may lead to IJ vein thrombosis and cause an embolism in the pulmonary artery. 17 In the current case, the anomalous lateral belly of the ST muscle may have compressed the IJ vein and caused thrombosis; however, this cannot be known for sure. In addition, the anomalous belly of the ST muscle lay between the glossopharyngeal and hypoglossal nerves near its termination.…”

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

“…A double blinded study [25] suggested that patients presenting for the first time with an episode of idiopathic venous thrombosis should receive anticoagulation for longer than 3 months. However, despite anticoagulation, IJV thrombosis may still occur in warfarinised patient [12]. To add, spontaneous resolution of IJV thrombosis in a patient presented with a neck abscess has been reported in the literature.…”

“…In some centres, contrast CT scanning has been favored as the first line investigation for patients with suspected IJV thrombosis [5]. 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.…”

“…There have been minor changes in practice over the years, mainly with the increasing use of low molecular weight heparin. Some case reports describe the use of intravenous heparin [1,12,24], and others [5], the merits of low molecular weight heparin. Anticoagulation with warfarin still seems to be the long term treatment of choice due to the risk of recurrence.…”

“…Low molecular weight heparin is used to prevent and treat thrombus formation because it does not cross the placenta [28] and treatment is advised to continue for the entire length of pregnancy [9]. Ball et al [12] recommended treating patients with Factor V Leiden deficiency with intravenous heparin followed by long-term warfarin maintaining the INR between 2.5 and 3.0.…”