Internal Jugular and Subclavian Vein Thrombosis in a Post-liver Transplant Patient.

Deema Algoblan,Luluwah Alaitah,Abdullah M Alotaibi

doi:10.7759/cureus.6557

Deema Algoblan, Luluwah Alaitah + Show 1 more

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https://doi.org/10.7759/cureus.6557

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Abstract

Internal jugular vein thrombosis (IJVT) is an unusual case of vascular disease of the upper limb veins, that could result in multiple complications if left untreated. IJVT can be subdivided into primary and secondary. Primary IJVT is when the thrombosis happens to someone without known risk factors, while secondary IJVT is when it happens to a person with previous risk factors. Our patient is a 66-year-old male with a history of hypertension and is status post-liver transplant in 2014 due to end-stage liver disease; he presented to the emergency department of the King Faisal Specialist Hospital & Research Center complaining of progressive right chest, flank, and back pain for the past month. On physical examination, the patient had right upper limb, chest, and neck increase in vascular markings and right supraclavicular swelling with no erythema. Upper extremity and neck ultrasound showed positive deep vein thrombosis (DVT) of the right internal jugular vein, right subclavian vein, and axillary vein. A chest X-ray showed right-sided pleural effusion with no mediastinal shift. Computer tomography (CT) demonstrated thrombosed right internal jugular and subclavian veins. General internal medicine service was consulted and they started the patient on Emxparine 1 mg/kg twice daily. The patient improved and is doing fine. He is scheduled for repeated outpatient follow-ups.

Highlights

Deep vein thrombosis (DVT) refers to the formation of one or more blood clots in the deep veins in the body
Upper extremity deep venous thrombosis (UEDVT) involves thrombosis of the deep veins of the arm, as they reach the entrance of the thoracic cavity
UEDVT is growing in frequency and that is mostly due to the increased use of central venous catheters and cardiac devices

Summary

Introduction

Deep vein thrombosis (DVT) refers to the formation of one or more blood clots in the deep veins in the body. There was no associated rash but the patient noticed increased vascular marking on his right upper extremity, chest, and neck. He denied any swelling or redness; he did notice a painless swelling in his right neck for two days. The patient had right upper limb, chest, and neck increase in vascular markings with no erythema. Upper extremity and neck ultrasound showed positive DVT of the right internal jugular vein, right subclavian vein, and axillary vein (Figure 2). Computed tomography (CT) revealed thrombosed right internal jugular and subclavian veins; the superior vena cava is patent with no associated adjacent masses; small right-sided pleural effusion with basilar atelectasis was noted (Figures 3-4). General internal medicine service were consulted and after reviewing the patient’s case they prescribed Emxparine 1 mg/kg twice daily, along with close follow-ups at their clinic

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