Thrombosis in an Internal Jugular Vein and an Upper Limb Deep Vein Treated with Edoxaban

Abstract

A 45-year-old man complained of swelling of the left side of his neck and left upper limb. Ultrasonography and enhanced computed tomography (CT) revealed thrombosis of the left internal jugular, subclavian, and brachiocephalic vein. Based on various examinations, the patient was diagnosed with idiopathic venous thrombosis early in his clinical course. There were no findings to suggest malignancy or abnormal coagulability. However, two months after the start of treatment, the patient was diagnosed with gastric cancer. Despite the presence of Trousseau syndrome, treatment with edoxaban (an oral anticoagulant), reduced the swelling dramatically without any bleeding complications.

Keywords: Trousseau syndrome; oral anticoagulant; upper-extremity deep vein thrombosis.

Figure 1.

Ultrasonography images (color flow Doppler imaging). A: A short-axis view of the left side of the neck. On the first ultrasound examination, a hyperechoic region of the thrombus in the left jugular vein thrombus coexisted with a hypoechoic region, which occluded the left jugular vein (arrow). B: The left subclavian approach. On the first ultrasound, a thrombus was present in the left subclavian vein (triangle) and another thrombus was present in the left brachiocephalic vein (arrow). C: The left subclavian approach. After 1 month of edoxaban treatment, the thrombi in the left subclavian vein (triangle) and left brachiocephalic vein (arrow) were smaller, and blood flow through these veins was increased.

Figure 2.

Contrast-enhanced computed tomography showing thrombi in the left internal jugular vein, left subclavian vein, and left brachiocephalic vein (arrows).