An unusually extensive internal jugular vein thrombosis.

To cite: Hadjiphilippou S, Huang DY. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202034 DESCRIPTION A 45-year-old female haemodialysis patient was admitted with a 10-day history of left-sided throbbing submandibular pain and swelling. She had presented with fever and left-sided neck pain to accident and emergency 3 days ago and was discharged home with antibiotics for presumed cellulitis. A left internal jugular tunnelled line for haemodialysis was inserted 6 weeks ago but she did not spike fevers or develop pain on dialysis and there was no line tenderness. On examination, diffuse left-sided neck swelling and tenderness was noted over the submandibular region. She could not open her mouth fully and had odynophagia. She was afebrile but had a C reactive protein of 189 mg/L. An ultrasound examination of the neck (figure 1) demonstrated a left internal jugular vein (IJV) thrombosis. A subsequent contrast-enhanced CT examination of her neck (figure 2) revealed the extensiveness of the thrombus, extending from the skull base to the left brachiocephalic vein. She was started on intravenous heparin prior to warfarin loading and was treated with 7 days of intravenous vancomycin and gentamicin. Following treatment, her symptoms resolved. IJV thrombosis is a rare condition. This is commonly caused by central vein catheterisation, malignancy or injection by intravenous drug users. Patients with IJV thrombosis typically present with neck pain and swelling. The most severe consequence of extensive IJV thrombosis is clinically significant pulmonary embolism. Despite limited consensus on treatments, this is generally managed with anticoagulation aimed at preventing thrombus propagation together with antibiotics if there is evidence of infection.