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
Ali Jendoubi
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
Source of Support: None, Conflict of Interest: None
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 2023 Mar 23];11:238-9. Available from: https://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
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.
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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.
Treatment of idiopathic internal jugular vein thrombosis in a healthy woman with enoxaparin and rivaroxiban: Case report and literature narrative review
Mhd Kutaiba Albuni, Bisher Sawaf, Elias Battikh, Mohammed Nasser, Fahmi Khan
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