eMedicine Specialties > Vascular Surgery > Medical Topics

Internal Jugular Vein Thrombosis: Follow-up

Author: Dale K Mueller, MD, Clinical Associate Professor of Surgery, Section Chief, Department of Surgery, University of Illinois College of Medicine; Co-Medical Director, Thoracic Center of Excellence, Vice-Chair, Department of Cardiovascular Medicine and Surgery, OSF St Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, SC
Coauthor(s): Michael J Dacey, MD, Consulting Staff, Department of Internal Medicine, Division of Critical Care, Kent County Hospital
Contributor Information and Disclosures

Updated: Sep 21, 2009

Outcome and Prognosis

Outcome is generally good but has similar morbidity and mortality to subclavian and axillary vein thrombosis. Pulmonary embolism can occur but is uncommon when full-strength systemic anticoagulation is in place. Rates of pulmonary embolism are 0.5% for isolated internal jugular (IJ) thrombosis and 2.4% for combined IJ and subclavian/axillary thrombosis. Mortality rates at 1, 3, and 12 months have been reported to be 14%, 33%, and 42%, respectively.5

Lemierre syndrome was associated with a mortality rate of higher than 50% prior to antibiotic use. However, when recognized early and treated with appropriate aggressive medical and surgical therapy, death is uncommon today. In one series of patients with septic thrombophlebitis occurring over a 9-year period, death occurred in 17% of patients.

Many patients have ongoing critical illness, often with multisystem involvement. This makes the contribution to mortality by the thrombus itself difficult to determine. The advantage of being aware of the diagnosis is that the physician can be more vigilant for potential complications and perhaps treat them earlier.

Future and Controversies

Studies have demonstrated similar morbidity and mortality compared with those of upper extremity deep vein thrombosis; therefore, consideration should be given to treat these 2 entities in a similar fashion. Randomized clinical trials should investigate anticoagulation as primary treatment and superior vena cava filter placement as secondary treatment in the setting of therapeutic anticoagulation that has failed or is contraindicated. Currently, no well-designed clinical trials are available to assess this. If, in fact, the incidence is as high as is suspected now, the question would lend itself well to a randomized controlled clinical trial.

Thrombolytic treatment has rarely been used. Consideration should be given for treatment of IJ thrombosis in the setting of pulmonary embolism with thrombolytics in a randomized clinical trial.

The best method for making the diagnosis once suspicion is raised should also be assessed. A study assessing the merits of CT scanning, MRI, and ultrasonography would not be difficult to perform.

 


More on Internal Jugular Vein Thrombosis

Overview: Internal Jugular Vein Thrombosis
Workup: Internal Jugular Vein Thrombosis
Treatment: Internal Jugular Vein Thrombosis
Follow-up: Internal Jugular Vein Thrombosis
References
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References

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Further Reading

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Keywords

internal jugular vein thrombosis, IJ vein thrombosis, thrombosis of the internal jugular vein, thrombosis of the IJ, sepsis, pulmonary embolism, acute oropharyngeal infection, septic thrombophlebitis of the IJ vein, septic thrombophlebitis of the internal jugular vein, central venous catheters, Lemierre syndrome, necrobacillosis, postanginal septicemia

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Contributor Information and Disclosures

Author

Dale K Mueller, MD, Clinical Associate Professor of Surgery, Section Chief, Department of Surgery, University of Illinois College of Medicine; Co-Medical Director, Thoracic Center of Excellence, Vice-Chair, Department of Cardiovascular Medicine and Surgery, OSF St Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, SC
Dale K Mueller, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, American Medical Writers Association, Chicago Medical Society, Illinois State Medical Society, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Dacey, MD, Consulting Staff, Department of Internal Medicine, Division of Critical Care, Kent County Hospital
Disclosure: Nothing to disclose.

Medical Editor

Richard M Stillman, MD, FACS, Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center
Richard M Stillman, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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