Internal jugular venous thrombosis due to Trousseau’s syndrome as the presenting feature of metastatic prostate carcinoma: a case report

Abstract

BackgroundInternal jugular vein thrombosis is a rare vascular event with a potentially fatal outcome. Of the known etiologies, internal malignancies, either known or occult, are well described. Even though malignancies are known to present with internal jugular vein thrombosis, it rarely occurs due to prostate carcinoma. Many cases of jugular vein and superior vena cava thrombosis secondary to malignancies are due to metastatic compression of veins. Recurrent and unusual vascular thrombosis due to hypercoagulability associated with malignancies is also known as Trousseau’s syndrome. Here we report a rare case of a patient with internal jugular vein thrombosis as a presenting feature of metastatic prostate carcinoma, which is a case of Trousseau’s syndrome.Case presentationA 75-year-old Sri Lankan man with hypertension, hyperlipidemia, and past history of spontaneous intracranial hemorrhage presented with a short history of painless swelling in his left supraclavicular fossa. An examination revealed the swelling was due to a thickened left external jugular vein. A duplex ultrasound scan revealed left-sided internal jugular, external jugular, and brachiocephalic venous thrombosis. Surveillance into underlying malignancies showed an irregular, hard prostate gland suspicious of prostate carcinoma, which was proven with histology, and biochemically. A computed tomography scan found extensive vertebral, pelvic bone, intra-abdominal lymph node metastasis, and a single right-sided lower lung metastatic lesion, with no direct involvement of the jugular vein.ConclusionsSpontaneous thrombosis of the internal jugular vein due to Trousseau’s syndrome is rare and unusual. Clinicians should promptly investigate for malignancies as it can be the first presentation of underlying occult malignancies. Although prostate carcinomas are rare to present with internal jugular vein thrombosis, this case illustrates the importance of having a high degree of suspicion in the appropriate clinical setting.

Internal Jugular Vein Thrombosis due to Chronic Kidney Disease: A Case Report

“…Bilateral IJV thrombosis is extremely rare and can be an indicator of early malignancy. 5 Bandara et al 6 reported that hidden malignancy should be investigated in patients with spontaneous IJV thrombosis. In a study conducted on IJV thrombosis involving 41 cases conducted by Hahn et al, 7 the cause was found to be malignancy in 22 (53.6%) patients, inflammatory diseases such as cervical abscess in 14 (34.1%) patients, and insertion of a central venous catheter in 2 (4.8%) patients, while no cause was identified in 3 (7.3%) patients.…”

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]. …”

“…A later retrospective study demonstrated PE rates of 0.5% and 2.4% for isolated IJV thrombosis and combined subclavian/axillary vein and IJV thrombosis, respectively [6–8]. …”

“…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]. …”

External jugular vein thrombosis secondary to deep tissue neck massage

“…Due to the increased risk of potentially fatal thromboembolic events, patients with internal jugular vein thrombosis receive full therapeutic anticoagulation. 13 , 14 The risk of propagation and embolization in patients with EJ thrombosis is less clear, but further thrombosis is possible. 9 However, most instances of this occur within the first few days of onset.…”