Internal Jugular Vein Thrombosis: Etiology, Symptomatology, Diagnosis and Current Treatment

Abstract

(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking.

Keywords: brain circulation; cerebral venous drainage; deep veins thrombosis; internal jugular vein; venous thromboembolism.

Figure 1

Flowchart of the systematic review, according to PRISMA guidelines [8].

Figure 2

Ultrasound jugular venous pulse in normal and in internal jugular vein thrombosis (IJVthr) cases. (A) B-mode ultrasound (US) of the IJV and the common carotid artery at J2 level, in the transversal aspect of the neck. The green line corresponds to the ECG trace. The blue line in the diagram corresponds to the recorded JVP i.e., the sequence of cross-sectional area variation for cardiac beat. The red line corresponds to the synchronized ECG trace. (B) The yellow arrow shows an IJVthr. The disappearance of the sequential peaks of the ultrasound JVP is well apparent.

Figure 3

Second level diagnosis of IJVthr. (A) Case of right IJVthr with a floating thrombus approaching the superior vena cava; high resolution ultrasound complemented by B-flow enhances the black floating thrombus. PL = pleural line. (B) Same case demonstrated by angio-TC.