Internal Jugular Vein Thrombosis Clinical Presentation

Updated: May 15, 2017
  • Author: Dale K Mueller, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Presentation

History and Physical Examination

The symptoms and signs of internal jugular (IJ) vein thrombosis are often very subtle, making it easy to overlook the diagnosis. Pain and swelling at the angle of the jaw and a palpable cord beneath the sternocleidomastoid both may be absent in a minority of patients. Once infection has set in, other objective findings may be found. The following clinical manifestations have been described [3] :

  • Fever (83%)
  • Leukocytosis (78%)
  • Mass or neck swelling (72%)
  • Cervical pain (66%)
  • Cord sign (39%)
  • Sepsis syndrome (39%)
  • Pleuropulmonary complications (28%)
  • Superior vena cava syndrome (11%)
  • Chylothorax (5%)
  • Jugular foramen syndrome (6%)
  • Increased intracranial pressure with symptoms that include headache, visual disturbances, and altered sensorium (rare) [4]
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Complications

Once the diagnosis is made, vigilance should be maintained for the following complications:

  • Pulmonary embolism (PE)
  • Subclavian vein thrombosis
  • Superior sagittal sinus thrombosis
  • Superior vena cava syndrome
  • Idiopathic intracranial hypertension (IIH; also referred to as benign intracranial hypertension or pseudotumor cerebri)
  • Laryngeal and lower-airway edema

Infected thrombophlebitis has the following complications:

  • Systemic sepsis syndrome
  • Septic emboli to lungs, liver, spleen, brain, skin, muscle, and bone marrow
  • Empyema
  • Septic arthritis
  • Renal failure
  • Hepatic dysfunction
  • Cerebral edema
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