A case of bilateral IJV thrombosis with left massive pleural effusion

Abstract

We report a case of middle aged male who presented with swelling of the neck since 2 months and shortness of breath since 1 month without any antecedent illness. Clinical examination was suggestive of diffuse neck swelling with left massive pleural effusion. USG neck revealed bilateral IJV thrombosis with diffuse neck cellulitis. Chest x-ray PA view showed homogenous opacity in the left upper and lower zone with obliteration of the costophrenic angle suggestive of left massive pleural effusion. CECT neck was done which suggested thrombosis of bilateral IJV with subcutaneous oedema with fat stranding noted in the neck with loculated abscess. CECT thorax revealed left massive pleural effusion with passive atelactasis of left lung. Pleural fluid cytology was suggestive of lymphoproliferative disorder. He was initially treated with antibiotics and anticoagulants. Patient was later referred to Oncology department for further management. Conclusion: Bilateral IJV thrombosis is a rare condition and also life threatening. It has been associated with various etiologies especially malignancies. Thus the diagnosis of bilateral IJV thrombosis needs extensive workup for any internal malignancies. As early detection and appropriate management can be lifesaving.