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Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Color Doppler study showing IJV thrombus seen as filling defect.
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fig3: Color Doppler study showing IJV thrombus seen as filling defect.

Mentions: USG neck showed well-defined hypoechoic lymph nodes measuring approx. 12 × 10 mm, 9 × 8 mm posterior to right IJV and common carotid artery (CCA) in the lower neck at level IV (Figures 1(a) and 1(b)). 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)). Echogenic fat plane noted between the lesion and right lateral wall of IJV was obscured with evidence of IJV invasion (Figures 2(a) and 2(b)). A medium level echogenic thrombus of size approx. 11(L) × 7(AP) × 8(T) mm was noted in adjoining right IJV in lower neck suggestive of IJV thrombosis (Figures 3(a) and 3(b)). Rest of the right IJV appeared normal with a normal flow on color Doppler. Contrast enhanced CT scan (CECT) of neck showed multiple lymph nodes at level IV on the right side and in the right supraclavicular region showing peripheral rim enhancement with central caseation necrosis (Figures 4, 5, and 6). A persistent filling defect was noted in right IJV in lower neck suggestive of IJV thrombosis (Figures 4, 5, and 6). Fine needle aspiration cytology (FNAC) of right supraclavicular swelling done after ultrasound and CECT neck revealed necrotizing granulomatous inflammation suggestive of tuberculosis. Patient was put on antituberculous treatment (ATT) along with anticoagulants after diagnosis since last one week and has been advised follow-up.


Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy
Color Doppler study showing IJV thrombus seen as filling defect.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120177&req=5

fig3: Color Doppler study showing IJV thrombus seen as filling defect.
Mentions: USG neck showed well-defined hypoechoic lymph nodes measuring approx. 12 × 10 mm, 9 × 8 mm posterior to right IJV and common carotid artery (CCA) in the lower neck at level IV (Figures 1(a) and 1(b)). 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)). Echogenic fat plane noted between the lesion and right lateral wall of IJV was obscured with evidence of IJV invasion (Figures 2(a) and 2(b)). A medium level echogenic thrombus of size approx. 11(L) × 7(AP) × 8(T) mm was noted in adjoining right IJV in lower neck suggestive of IJV thrombosis (Figures 3(a) and 3(b)). Rest of the right IJV appeared normal with a normal flow on color Doppler. Contrast enhanced CT scan (CECT) of neck showed multiple lymph nodes at level IV on the right side and in the right supraclavicular region showing peripheral rim enhancement with central caseation necrosis (Figures 4, 5, and 6). A persistent filling defect was noted in right IJV in lower neck suggestive of IJV thrombosis (Figures 4, 5, and 6). Fine needle aspiration cytology (FNAC) of right supraclavicular swelling done after ultrasound and CECT neck revealed necrotizing granulomatous inflammation suggestive of tuberculosis. Patient was put on antituberculous treatment (ATT) along with anticoagulants after diagnosis since last one week and has been advised follow-up.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus