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LETTER TO EDITOR
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 238-239

Incidental detection of spontaneous floating internal jugular vein thrombosis with acute pulmonary embolism


Department of Anaesthesia and Intensive Care, Charles Nicolle Hospital of Tunis, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia

Correspondence Address:
Ali Jendoubi
Department of Anaesthesia and Intensive Care, Charles Nicolle Hospital of Tunis, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.203026

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Date of Web Publication27-Mar-2017
 


How to cite this article:
Jendoubi A. Incidental detection of spontaneous floating internal jugular vein thrombosis with acute pulmonary embolism. Saudi J Anaesth 2017;11:238-9

How to cite this URL:
Jendoubi A. Incidental detection of spontaneous floating internal jugular vein thrombosis with acute pulmonary embolism. Saudi J Anaesth [serial online] 2017 [cited 2019 Dec 10];11:238-9. Available from: http://www.saudija.org/text.asp?2017/11/2/238/203026



Sir,

Internal jugular vein thrombosis (IJVT) is a rare but potentially fatal condition.[1] It is usually caused by catheterization history of central venous catheter (CVC), malignancy, thrombophilia, or local infection.[2],[3],[4] Spontaneous IJVT occurs when there are no apparent predisposing causes. IJVT without CVC may be the first manifestation of an occult malignancy and it must be ruled.[5] We report here a rare case of idiopathic IJVT complicated with pulmonary embolism (PE).

A 75-year-old male was admitted to the Intensive Care Unit (ICU) for acute exacerbation of chronic obstructive pulmonary disease requiring endotracheal intubation and mechanical ventilation. On admission, we incidentally detected floating thrombosis in the right IJV [Figure 1]a, with spontaneous echo contrast [Figure 1]b during the ultrasound-guided IJV cannulation [Video 1].
Figure 1: (a) Long-axis view: Floating thrombosis of the right internal jugular vein. (b) Short-axis view: Spontaneous echo contrast in the right internal jugular vein. (c) Transthoracic echocardiography four cavity view: Right ventricle dilation and paradoxical interventricular septal motion

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Transthoracic echocardiography showed severe dilatation of the right chambers, paradoxical wall motion septum [Figure 1]c, with pulmonary hypertension of 80 mmHg.

A chest computed tomography confirmed acute bilateral PE involving segmental pulmonary arteries. The patient was treated with intravenous unfractionated heparin. This patient had no malignancy, coagulation disorder, or infection.

This case highlights the value of bedside ultrasound in the ICU setting. Early diagnosis and appropriate management are important to prevent potentially fatal complications from this condition. The patient needs to be investigated thoroughly to rule out a pathological cause of IJV thrombosis, especially deep neck infections, coagulation disorders, and local or distant malignancies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pino Rivero V, Pantoja Hernández CG, González Palomino A, Trinidad Ramos G, Pardo Romero G, Marcos García M, et al. Internal jugular vein spontaneous thrombosis. Clinical case and review of the literature. An Otorrinolaringol Ibero Am 2005;32:553-9.  Back to cited text no. 1
    
2.
Mamede RC, Resende e Almeida KO, de Mello-Filho FV. Neck mass due to thrombosis of the jugular vein in patients with cancer. Otolaryngol Head Neck Surg 2004;131:968-72.  Back to cited text no. 2
    
3.
Erkoç R, Uzun K, Yuca K, Etlik Ö, Doğan E, Sayarlıoğlu H, et al. Internal jugular vein thrombosis two different etiologies. Eur J Gen Med. 2005;2:123-8.  Back to cited text no. 3
    
4.
Yau PC, Norante JD. Thrombophlebitis of the internal jugular vein secondary to pharyngitis. Arch Otolaryngol 1980;106:507-8.  Back to cited text no. 4
    
5.
Barros FS, Sandri JL, Prezotti BB, Nofa DP, Salles Cunha SX, Barros SD. Pulmonary embolism in a rare association to a floating thrombus detected by ultrasound in the basilic vein at the distal arm. Rev Bras Ecocardiogr Imagem Cardiovasc 2011;24:89-92.  Back to cited text no. 5
    


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