Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy.

Sanjay Khaladkar,Kunaal Jain,Arijit Ghosh,Surbhi Chauhan,Avadhesh Chauhan

doi:10.1155/2016/5184196

Abstract

Tuberculosis is a common infectious disease with a high prevalence in developing countries and presents a major public health issue. Internal jugular vein (IJV) thrombosis is a rare complication in tuberculous cervical lymphadenopathy. We report a case of 26-year male patient with a history of low-grade evening rise in fever, dry cough, loss of appetite, and loss of weight with swelling in lower neck on right side. Ultrasonography (USG) neck showed well-defined hypoechoic lymph nodes posterior to right IJV and common carotid artery in the lower neck at level IV and in the right supraclavicular region showing central necrotic areas with adjoining IJV thrombosis. The association between tuberculosis and deep vein thrombosis is rare. Awareness of IJV thrombosis in isolated cervical lymphadenopathy needs high diagnostic suspicion and prompt treatment to avoid fatal complication. Our case is rare as there was isolated tuberculous cervical lymphadenopathy with adjoining IJV thrombosis. Both USG and computed tomography (CT) are accurate and reliable radiological investigations for detecting IJV thrombosis along with cervical lymph nodes. They are useful in assessing surrounding soft tissue and fat planes and knowing the size and extent of cervical lymphadenopathy. USG is inexpensive and readily available for monitoring response to treatment.

Highlights

Lymph node measuring approx. 31 × 14 mm was noticed in the right supraclavicular region showing central hypoechoic areas due to necrosis showing multiple medium level internal echoes
A linear hypoechoic lesion of size approx. 20 × 5 mm was noted extending from this lymph node medially towards right lateral wall of internal jugular vein (Figure 1(c))
A medium level echogenic thrombus of size approx. 11(L) × 7(AP) × 8(T) mm was noted in adjoining right Internal jugular vein (IJV) in lower neck suggestive of IJV thrombosis (Figures 3(a) and 3(b))

Summary

Introduction

It is usually associated with central venous catheterization, trauma, neck surgery, coagulation disorders, hypercoagulation states, endocrine alteration, local infection or malignancy, occult malignancy, neck massage, deep neck infection, and intravenous drug abuse [1, 2]. Tuberculous cervical lymphadenopathy with IJV thrombosis is extremely rare complication of isolated tuberculous cervical lymphadenopathy [3]

Case Report

Discussion