Internal Jugular Vein Thrombosis Research Articles

A CASE OF DUAL–SITE LEFT VENTRICULAR PACING PERFORMED VIA A PERSISTENT LEFT SUPERIOR VENA CAVA IN A PATIENT WITH COMPLETE ATRIO–VENTRICULAR BLOCK AND RIGHT SUPERIOR VENA CAVA OCCLUSION

Abstract Patient A 64 year old male admitted for syncope. EKG presented 3rd degree AV block. Attempting to place temporary pacemaker was unsuccessful due to occlusion of the right femoral vein and the presence of a catheter for hemodialysis in the left femoral vein. He also has complete thrombosis of the right internal jugular vein, proximal superior vena cava and right femoral vein. He was referred to ICCU for monitoring, asymptomatic with no signs of congestion or hypoperfusion. Dopamine was started at 4 mcg/kg/min and then isoprenaline 0.06 mcg/kg/min. Initial work up Echocardiography showed depressed LV ejection fraction (LVEF 40%). Chest and abdomen angio–CT showed persistence of a superior left vena cava (PSLVC), which drained in the coronary sinus (CS). Right axillary and subclavian veins were occluded, and also right superior vena cava and right jugular vein. Left jugular, axillary and subclavian veins were pervious. Left femoral and right iliac–femoral veins showed significantly narrowing of the vessel lumen. Diagnosis and Management Our indication for this patient was CRT rather than RV pacing. The implant of a leadless AV pacemaker was also considered, but it was considered unfeasible due to limited access from the femoral veins. The presence of a PSLVC cava draining into CS was confirmed with angiography in the EP Lab. At the beginning of the procedure two episodes of asystole occurred. A first bipolar lead was rapidly placed in a postero–lateral branch of the CS, to obtain a stable temporary pacing. We then placed a quadripolar, active fixation, left ventricular pacing lead via the PSLVC into an antero–lateral branch of the CS. Finally, we placed a right atrium active fixation pacing lead in the right atrium again through the PSLVC. Vascular accesses were cephalic left vein and axillary vein. Acceptable sensing and pacing parameters were achieved. The bipolar LV lead was connected to the IS–1 RV port for sensing and the quadripolar lead was connected to the IS–4 LV port for pacing. Programming was DDDR 60–130 with active LV pacing only. Total procedural time was 180 minutes. No complications occurred. At discharge electric parameters were stable. Echocardiography showed an improvement in LVEF (45% vs 40%) and ECG showed atrio–ventricular LV pacing. Conclusion As far as we know this is the first reported case of a CRT delivered by two left ventricle pacing leads both placed via a PLSVC, with no need to place a pacing lead in the right ventricle.

Periosteal reaction in jugular foramen secondary to ipsilateral internal jugular vein thrombosis.

Periosteal reaction in jugular foramen secondary to ipsilateral internal jugular vein thrombosis.

Pediatric Lemierre's Syndrome: A Comprehensive Literature Review.

Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. Lemierre syndrome has been called "the forgotten disease," with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease's treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

Atypical Presentation of Pemphigus Vulgaris with Co-Existing Carcinoma Lung and Acute Onset Internal Jugular Vein Thrombosis

Atypical Presentation of Pemphigus Vulgaris with Co-Existing Carcinoma Lung and Acute Onset Internal Jugular Vein Thrombosis

Recurrent failure of ART, thrombosis and thrombophilia

In recent years, the number of risk factors for thrombosis associated with pregnancy has increased substantially due to the active introduction of new medical technologies not used 30 years ago or because their role in emerging thrombosis has not been studied, e.g., during pregnancy after assisted reproductive technologies (ART) particularly in vitro fertilization (IVF). The risk of venous thromboembolic complications (VTEС) related to ovarian hyperstimulation during ART is often overlooked. We present the case of a 37-year-old woman who developed thrombosis of the right internal jugular vein 3 weeks after embryo transfer within the IVF protocol. Ovarian hyperstimulation during hormonal IVF protocols provokes procoagulant changes in the hemostasis and fibrinolysis system able to result in venous and arterial thrombosis. The localization of VTEС typical to ART is more often located in the internal jugular vein being accompanied by neck pain and edema. Thrombosis risk factors should be assessed in all women in the IVF program, and appropriate thromboprophylaxis should be carried out to all high risk subjects.

Isolated Facial Vein Thrombosis in a Case of Lemierre's Syndrome

Lemierres disease is an anaerobic post-anginal sepsis presenting in the form of septic thrombosis of internal jugular vein. A 13-year old boy presented with high fever delirium trismus parotid edema and thrombophlebitis of facial vein. Causative agent was Streptococcus intermedius. The condition responded to metronidazole and linezolid. This case is reported due to its rarity.nbsp

Spectrum on Non-Surgical Causes of Internal Jugular Vein Thrombosis In Otorhinolaryngology Practice

Internal jugular vein thrombosis is an uncommon entity secondary to various aetiologies. In the pre-antibiotic era, it was commonly associated with Lemierre syndrome, a septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. With the advent of antibiotics, Lemierre syndrome has become a rare entity and is often overlooked. Internal jugular vein thrombosis may also occur in the setting of malignancy, a combination referred to as Trousseau’s syndrome, which is not well documented.

Non-traumatic Subcapsular Hematoma of the Liver in a Patient under Rivaroxaban: A Rare Clinical Occurrence

Direct oral anticoagulants are used in the management and prophylaxis of venous thromboembolism (VTE) and other thrombotic diseases including non-valvular atrial fibrillation. The most serious complication of DOAC agents is bleeding, dominated by gastrointestinal hemorrhages, even if the bleeding risk is much rarer compared to VKA therapy. DOACs are sometimes linked to hepatotoxicity which can sometimes lead to severe hepatocellular insufficiency and also to non-hemorrhagic gastrointestinal disorders. We present a rare clinical entity of a spontaneous subcapsular hematoma of the liver in patient diagnosed with thrombosis of the right internal jugular vein treated with rivaroxaban, undergoing chemotherapy and hormonotherapy after surgery for breast cancer. The diagnosis was confirmed by imagery (abdominal CT scan) after clinical manifestation of an onset pain at the right hypochondrium of the abdomen. Conservative treatment was used in the patient with close follow up after hospital discharge.

Thyroid Lesion with Thrombus in Great Veins Points towards Particular Pathology - A Case Report and Review in Literature

Differentiated carcinoma of thyroid is regarded as one of those malignancies which if dealt at the right time lead to good survival and outcome but if the management is delayed then not only it can lead to loss of precious life but poses a surgical challenge in advanced cases. We are presenting an advanced carcinoma thyroid with thrombus extending to right atrium presenting with swelling in front of neck from 2 months, insidious in onset gradually progressive. Swelling was more prominent over right side of face & right upper limb. During evaluation there was a lesion arising from right lobe of thyroid gland 10.6 x 5.7 x 5.2cms. Right internal jugular vein thrombosis and inferiorly thrombosis is extending into right brachiocephalic vein, superior vena cava (SVC) and right atrium. Even in the absence of malignant findings on cytology, the presence of a tumour thrombus in the thyroid vein or internal jugular vein is highly suggestive for malignancy. It is a significant discovery that raises strong suspicions about distant metastases.

Lemierre's Syndrome Secondary to Shoulder Hematoma Complicated by COVID-19: A Case Report.

This case report illustrates a unique presentation of Lemierre's syndrome precipitated by Fusobacterium necrophorum. This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.

A case of blindness caused by Lemierre's syndrome

Key Clinical MessageWe describe a patient who lost her vision because of Lemierre's syndrome. Ophthalmologic complications of Lemierre's syndrome are rare, and very few cases have been reported. Clinicians need to recognize that it is a serious condition that can lead to blindness in some cases.AbstractLemierre's syndrome is a systemic septic embolism resulting from thrombophlebitis of the internal jugular vein. We report a case of blindness caused by Lemierre's syndrome, despite prompt diagnosis and early treatment. A 36‐year‐old woman was transported to our hospital. She presented with fever, facial swelling, and right visual acuity deterioration. Contrast‐enhanced computed tomography revealed a retropharyngeal abscess and right internal jugular vein thrombosis. Blood culture revealed Fusobacterium necrophorum, suggesting Lemierre's syndrome. The patient had septic shock and disseminated intravascular coagulation. We diagnosed her visual impairment as orbital‐apex syndrome due to spread of inflammation. After 6 weeks of antimicrobial drug treatments, her general condition had improved, and the retropharyngeal abscess had disappeared. On Day 49 of her illness, she was transferred to a rehabilitation hospital, but her visual acuity was not restored. Clinicians should be aware that Lemierre's syndrome can, although rarely, cause blindness.

Concurrent Isolated Hypoglossal Nerve Palsy Induced by Jugular Vein Thrombosis, Cervical Plexus Masses, and Vestibular Schwannoma: A Complex Case Report Highlighting Anatomical Pathways and Clinical Challenges

Background: Hypoglossal nerve palsy is typically observed alongside other cranial nerve impairments, with isolated cases being infrequent and posing diagnostic complexities. Originating intracranially, the nerve traverses the skull and neck, governing tongue motility. Lesions are classified as supranuclear, nuclear, or infranuclear, engendering tongue deviation towards the affected side. Due to its proximity to crucial structures, hypoglossal nerve palsy often coincides with supplementary symptoms. Etiologies encompass skull base metastases, carotid artery pathologies, and trauma. This study explores less conventional triggers such as hypoglossal nerve palsy following thyroidectomy, jugular vein thrombosis, cervical plexus masses, and Vestibular Schwannoma. Case Description: A 38-year-old female presented to the Neurology outpatient clinic with leftward tongue deviation and left-sided neck and shoulder pain accompanied by stiffness that had begun several months prior. In addition to the tongue deviation, she reported minor dysphagia, blurry vision, and intermittent numbness on the left side of her scalp. MRI and duplex ultrasound verified the presence of left internal jugular vein (IJV) thrombosis. The patient was initially prescribed Eliquis and acetazolamide, with slight improvements in symptoms, though medication use ceased due to side effects. During a subsequent follow-up visit, persistent tongue deviation and worsening left shoulder pain prompted additional cervical imaging. A new cervical spine MRI revealed a 15x14 mm nodular dural enhancement with a paraspinal soft tissue mass at the C2 level. Concurrently, multiple cranial nerve palsies were detected during the physical examination. Unfortunately, the patient was subsequently diagnosed with breast cancer. To rule out brain metastases related to her breast cancer, an additional brain MRI was performed, revealing a newly formed 2.3x1.6x1.2 cm left cerebellopontine angle mass adjacent to the internal auditory canal (IAC), suggestive of a vestibular schwannoma but without evidence of metastatic disease. The patient's care involved a multidisciplinary team, including hematologist-oncologists, neurosurgeons, and neurologists. Conclusion: This case report highlights the less common causes of hypoglossal nerve palsy, such as jugular vein thrombosis, cervical plexus masses, and Vestibular Schwannoma. The persistence of the patient's palsy is attributed to the cumulative impact of these anatomical factors on the hypoglossal nerve. This underscores the diagnostic challenges posed by isolated hypoglossal nerve palsy and emphasizes the importance of comprehensive clinical evaluation and imaging for accurate diagnosis.

Lemierre syndrome: the forgotten disease—a case series

BackgroundThe aim of this work is to share the authors’ experience and assist therapeutic decision-making in the management of Lemierre syndrome (LS). This is a retrospective descriptive study carried out in the stomatology, maxillofacial surgery, and ENT departments of the teaching hospital of Treichville (Abidjan, Côte d’Ivoire). LS cases managed from 2013 to 2023 were included in the study.ResultsEight patients were enrolled (six men and two women). Internal jugular vein thrombosis was unilateral in 7 cases and bilateral in one. No germs were found in four patients. In one patient, a bacterial co-infection was responsible for the thrombosis. Surgical debridement was systematically performed in cases of necrosis. Anticoagulation was justified in three patients. No deaths were observed.ConclusionThis work describes the epidemiological, clinical, therapeutic, and evolutionary aspects of LS. The management of LS should not be improvised. The choice of surgical debridement and anticoagulation depends on specific situations.

Abstract 109: Endonasal Endoscopic Approach Associated Cerebral Vasospasm and Management: A Case Report

Introduction Endoscopic endonasal approach(EEA) techniques have been increasingly utilized and have been associated with development of cerebrospinal fluid(CSF) leak, meningitis, diabetes insipidus post‐operatively. Cerebral vasospasm following EEA has rarely been described. Here, we describe the clinical course and management of a patient who underwent EEA for encephalocele repair whose course was complicated by postoperative subarachnoid hemorrhage(SAH) and cerebral vasospasm. Methods n/a Results Case Presentation: 40 year old female with past medical history significant for cerebral venous sinus stent on aspirin, CSF rhinorrhea secondary to right nasal encephalocele s/p endoscopic transnasal transethmoidal repair with nasoseptal flap reconstruction and lumbar drain placement eleven days prior presented with speech difficulties and right sided weakness. On exam, patient was noted to have mild right hemiparesis and expressive aphasia. MRI brain showed subacute infarcts in left greater than right frontal lobes, corpus collosum and right anterior perforated substance. MRA head demonstrated multifocal arterial stenosis. In light of postoperative CT head showing SAH in the basilar, perimesencephalic, prepontine cisterns, interhemispheric fissure and right frontal sulci as well as intraventricular hemorrhage in fourth ventricle, her presentation was thought to be secondary to cerebral vasospasm in the setting of postoperative SAH. She was treated with intravenous hydration, permissive hypertension with head of bed in flat position and transferred for further evaluation. On arrival, she continued have mild right hemiparesis and aphasia. Repeat CTA head/neck and CT perfusion showed severe stenosis of bilateral M1 segments and left greater than right A1 segments as well as ischemic penumbra in left ACA/MCA watershed territory. Diagnostic cerebral angiogram showed bilateral severe A1 stenosis and mild to moderate bilateral M1 and supraclinoid ICA stenosis which improved with intra‐arterial verapamil. She was started on nimodipine. Systolic blood pressure was augmented with vasopressors for goal of 150‐180mmHg. Daily TCDs were followed. She developed worsening right leg weakness following day, thus she was taken for repeat diagnostic cerebral angiogram during which time she was re‐administered intra‐arterial verapamil with improvement in vasospasm. After the second treatment, she had improvement in speech and motor strength. Systolic blood pressure goal was gradually normalized. She was noted to have incidental left internal jugular (IJ) vein thrombosis for which anticoagulation was held in the setting of recent neurosurgical procedure and SAH. Workup for vasculitis and hypercoagulability was unrevealing. Lumbar puncture demonstrated 13 WBC/cu mm with lymphocytic predominance(90%), 23 RBC/cu mm, glucose 89mg/dl, protein 30mg/dl. CSF cultures were negative. Pleocytosis in CSF was attributed to recent neurosurgical procedure. Her neurological exam improved to baseline on hospital day(HD) 9.On HD12, she was found to have left common femoral deep venous thrombus in addition to the left IJ thrombus. Anticoagulation with low dose heparin infusion was started which was transitioned to apixaban on discharge. She was discharged home on HD20. Conclusion We report a case of EEA associated with severe multifocal cerebral vasospasm secondary to postoperative SAH that was successfully treated with induced hypertension, oral nimodipine and intra‐arterial verapamil as an adjunct therapy with an excellent outcome.

Case Report - Trauma Induced Vernet’s Syndrome

Trauma induced Vernet’s syndrome is a rare presentation and very few case reports exist in medical literature. Here we report a 40-year-old male with no significant medical history who presented with clinical features of right IX, X, and XI cranial nerve palsy after trauma to the neck and was diagnosed with right internal jugular vein thrombosis on imaging causing compression and symptoms. Patient symptomatically improved with anti-coagulation and was advised regular follow-up.
 This case report emphasizes on the need for identifying trauma induced thrombosis as one of the uncommon causes of Vernet’s syndrome with better prognosis and the need for early imaging techniques in such cases.
 The jugular foramen-crossing IX, X, and XI cranial nerves are paralyzed in Vernet syndrome. The posterolateral sulcus of the medulla oblongata is where the glossopharyngeal nerve, vagus nerve, and spinal accessory nerves emerge. They then travel via the basal cistern before leaving the skull by the jugular foramen.[1] Primary tumours like paraganglioma, meningioma, and schwannoma, metastatic tumours at the base of the skull, inflammation like meningitis and malignant otitis external, sarcoidosis, Guillain-Barre syndrome, vascular events like dissection, thrombosis, or aneurysm, and trauma are the main causes of Vernet syndrome.
 Vernet syndrome caused by trauma is incredibly rare and is typically brought on by penetrating trauma or fractures impacting the posterior skull base. Approximately 30 cases of Jugular foramen syndrome caused by a fracture in the jugular foramen area have been documented to date.[2,3] Only one posttraumatic Vernet case without a fracture has, however, been documented so far,[4] and this is one of them.

Comparison of supraclavicular brachiocephalic and femoral vein approaches for tunneled dialysis catheter placement in patients with thrombosed internal jugular veins.

There is still debate on the best access route in case of bilateral internal jugular vein thrombosis. We aimed to compare the safety, effectiveness, and outcomes of tunneled dialysis catheter placement via supraclavicular brachiocephalic and femoral vein approaches in patients with bilateral internal jugular vein thrombosis. Between January 2018 and December 2021, data of the patients in whom tunneled dialysis catheters were placed via the supraclavicular brachiocephalic vein (n = 42) and femoral vein (n = 57) approaches were extracted. Patient demographics, technical and clinical success rates, complications, and outcomes were noted. The Likert scale was used to assess patient satisfaction. Forty two (42.4%) patients were men, and the mean age was 61.9 (range, 12-93) years. The technical and clinical success rate was 100% for both groups. No major complication was encountered. The mean follow-up period was 497.5 (range, 32-1698) catheter days. Thirty-day patency was similar for the brachiocephalic vein and femoral vein group (40 [95.2%] vs. 55 [96.5%], p = 0.754). Also, primary and cumulative patency rates were comparable (p = 0.158; p = 0.660). The infection rate was 2.6 and 4.1 per 1000 catheter days for the brachiocephalic vein and femoral vein group. The infection-free survival was significantly higher in the brachiocephalic vein group (71.9% vs. 35.3% at 12 months, p < 0.001). Patient satisfaction was higher in the brachiocephalic vein group (median satisfaction, 5 vs. 4, p < 0.001). Both supraclavicular brachiocephalic vein and femoral vein approaches have high technical and clinical success with comparable patency rates. However, low infection rate and high patient satisfaction make the supraclavicular brachiocephalic vein approach a reasonable alternative before proceeding to the femoral vein access.

Managing Hemostasis in Space.

Human space travel requires exposure to weightlessness, ionizing radiation, isolation, and austerity. A recent report of internal jugular vein thrombosis in astronauts in low Earth orbit confirms that these exposures also affect vascular biology to influence diseases of thrombosis and hemostasis. This brief review summarizes the known influences of space travel on inflammation, blood coagulation, and the cardiovascular system and conceptualizes how they might combine to affect thrombosis and hemostasis. In the event of a major thrombotic or bleeding emergency, it is anticipated that the unique physiological influences of the space environment and logistical limitations of providing medical care in space would require a response that is unique from our current experience. We also look towards the future to discuss lessons learned from our current experiences on Earth and in space.

Lemierre’s syndrome complicating deep neck abscess: a case report

BackgroundLemierre’s Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre’s Syndrome caused by Streptococcus anginosus with deep neck abscess.Case presentationA 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre’s syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization.ConclusionsAlthough Lemierre’s syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.

439 A review of the management of Anti-coagulation and anti-platelet medication in surgical patients in a University Hospital

Abstract Management of surgical patients on anti-coagulation and anti-platelet medication can be challenging. Balance between discontinuation, with thrombotic risk, and continuation or early re-initiation with risk of bleeding should be considered. In emergency setting patients are managed depending on clinical situation. Aim To review the management of anticoagulant or antiplatelet therapy in acute and elective surgical patients. Methods Method: Electronic data was retrospectively reviewed for both elective and emergency admissions to surgical ward during two weeks period. Data including age, sex, admission diagnosis, indication and nature of anti-thrombotic or antiplatelet medication, and thromboembolic or bleeding complications were collected. Results 30 patients (19 male, 11 female) with a mean age of 74 (54-90) were reviewed. 22 patients were emergency admission and 8 were elective. All elective cases had their medication withheld. Three patients developed complications including 1 rectal bleeding, 1 post liver biopsy bleed and 1 internal jugular vein thrombosis. 17 emergency patients had their medication withheld. 5 patients underwent surgery and 7 patients had endoscopic invasive procedures (ERCP). One patient developed bowel ischemia from arterial thrombosis following emergency open cholecystectomy. Among the 5 patients who continued the medication one patient had ERCP and others did not receive any intervention. Conclusion Patients on anti-coagulation and anti-platelet medication undergoing invasive procedure can develop thrombo-embolic or bleeding complication.

Internal Jugular Vein Thrombosis Following Cortical Mastoidectomy in Coronavirus 2019 Era

Internal Jugular Vein Thrombosis Following Cortical Mastoidectomy in Coronavirus 2019 Era