Internal jugular vein thrombosis

A complication of central venous access, malignancy, head and neck infections, intravenous drug abuse, polycythemia, hyperhomocysteinemia and can occur spontaneously as well.

Can lead to sepsis, chylothorax, papilledema, airway obstruction and pulmonary embolism.

Diagnosis difficult and requires a high index of clinical suspicion.

Most commonly caused today by use of venous access devices.

Can be located in the intracranial internal jugular vein to the junction of the internal jugular vein and the subclavian vein that forms the brachiocephalic vein.

May become secondarily infected and produce a septic thrombophlebitis.

Extension of an oropharyngeal infection can lead to an internal jugular thrombosis known as the Lemi2242e syndrome.

Rates occur in 25-30% of cases after neck dissection.

May occur after placement of hemodialysis catheters.

May be related to intravenous drug abuse.

Associated with deep neck infections, narcotizing soft tissue infections of the neck, head and neck malignancy, hypercoaguable states of malignancy, factor V Leiden, protein c, Protein S, or antithrombin III deficiency, trauma, hyperhomocysteinemia, polycythemia and spontaneous causes.

May become infected and produce a septic thrombophlebitis.

Gram-positive organisms have resistance to beta-lactam antibiotics frequently the cause of septic thrombophlebitis associated with central venous catheters.

Reports of a 40% incidence of beta-lactam resistant organisms with catheter induced thrombosis of the internal jugular vein.

Anaerobic organisms often predominate in Lemi2242e syndrome.

Occurs in 25-30% of patients with neck dissection and hemodialysis catheter placement.

Frequently thrombosed vessel will recanalize and have long term patency.

Events associated with central venous catheters occurs frequently and frequency may be as high as 66% occurring at some time during a hospitalization in those who had an internal jugular vein catheter placed.

Frequency of such events increased in the critically ill, and those with low cardiac output or shock in the presence of an internal jugular vein catheter.

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