甲状腺乳头状癌伴颈内静脉癌栓的临床特点

目的 探讨甲状腺乳头状癌伴颈内静脉癌栓的临床特点.方法 回顾性分析2例复发性甲状腺乳头状癌伴颈内静脉癌栓患者的临床表现,影像学检查资料、治疗方式及临床转归.结果 2例患者除颈部肿物外,均无明显临床症状,经CT检查均发现颈内静脉内低密度影,但不能确诊为癌栓,其中1例经彩色多普勒超声及超声造影检查可诊断颈内静脉癌栓.2例均接受了甲状腺全切除+单侧颈淋巴清扫+同侧颈内静脉切除术,术后病理证实为甲状腺乳头状癌伴颈内静脉癌栓.2例患者分别于术后4个月、13个月因肿瘤局部未控死亡.结论 甲状腺乳头状癌伴颈内静脉癌栓临床症状缺乏特异性,术前诊断主要依靠影像学检查.手术切除全甲状腺及受累静脉有可能延长患者生存期,术后还应补充放疗及131I治疗,但总体预后不良.     

Internal jugular vein thrombosis

Internal jugular vein thrombosis is a vascular disorder that is easily overlooked or misdiagnosed. It occurs in a variety of clinical settings which disrupt normal blood flow through the internal jugular vein. Intravenous drug abusers represent a high risk group in this study. Diagnosis is readily made by computed tomography. Seven patients are presented, with discussion of the pathogenesis, clinical findings, radiologic features, potential complications, and treatment rationale.     

Internal jugular vein thrombosis associated with acute mastoiditis in a pediatric age.

OBJECTIVE: To discuss the clinical aspects and management of internal jugular vein thrombosis associated with acute otitis media. STUDY DESIGN: Case reports and review of the literature. SETTING: University hospital, tertiary referral center. PATIENT: The authors describe two cases of internal jugular vein thrombosis, without sigmoid sinus thrombosis, secondary to acute otomastoiditis. INTERVENTION: Jugular vein thrombosis was diagnosed in both cases by observation of filling defects of the involved jugular bulb on contrast-enhanced computed tomography and confirmed by conventional magnetic resonance and magnetic resonance venography. RESULTS: Both patients recovered after recanalization of the vessel concomitant to anticoagulation and antibiotic treatment associated with a simple mastoidectomy. CONCLUSION: Internal jugular vein thrombosis may be a complication of acute otitis media, without involvement of the sigmoid sinus and with a starting point in the jugular bulb. Anticoagulation associated with antibiotic therapy can be considered a safe and effective treatment. Surgery should only be performed to eliminate the source of infection from the middle ear and mastoid.     

Internal jugular vein thrombosis following ovarian hyperstimulation

Superovulation therapy with in vitro fertilization (IVF) treatment may result in ovarian hyperstimulation syndrome and a hypercoaguable state. The site of thrombus formation is commonly in the upper venous extremities. One case of bilateral internal jugular vein thrombosis following ovarian hyperstimulation is described. The clinical presentation, investigations and management are discussed.     

Internal jugular vein thrombosis following functional neck dissection

Twenty-five patients on whom 27 functional neck dissections were performed for upper aerodigestive tract squamous carcinoma were prospectively investigated to determine the frequency of venous thrombosis on the side of the neck dissection. Retrograde venography, performed within 1 month postoperatively, was used to determine the status of the internal jugular vein. Nineteen veins were patent at venography, but ipsilateral occlusion was demonstrated in 8. In 5 of the 8 patients, venous thrombosis followed major wound sepsis or fistula formation. No causes for the remaining 3 cases of internal jugular vein thromboses were identified. Possible mechanisms for “spontaneous” internal jugular vein occlusion following functional neck dissection are endothelial trauma, reduction in venous flow during anesthesia, and the altered coagulability profile of some cancer patients. The finding that functional neck dissection does not always maintain patency of the internal jugular vein is especially important when surgical treatment to the opposite side of the neck is planned, as the surgeon may be faced with an unexpectedly complicated postoperative course.     

Spontaneous internal jugular vein thrombosis associated with distant malignancies

Internal jugular vein (IJV) thrombosis is an extremely rare vascular disease that is easily overlooked or misdiagnosed. It is usually secondary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies, either known or occult, are also uncommon and not well documented in the etiology of IJV thrombosis. A previously healthy, 48-year-old man presented to our Ear, Nose and Throat (ENT) Department with pain and swelling of the right side of the neck, which had been going on for a period of 9 days, with the absence of any other ENT symptoms. Examination of his neck showed swelling and tenderness along the anterior border of the right sternocleidomastoid muscle. An ultrasound scan of the neck confirmed right IJV thrombosis. Further investigation to determine the cause for the thrombosis revealed two coincidental malignancies: prostate and lung. This shows that every patient with spontaneous thrombophlebitis must undergo a careful history, a complete physical examination and a thorough investigation to avoid missing or delaying the diagnosis of a hidden malignancy.     

Thrombosis of internal jugular vein associated with acute parotitis

We report a case of thrombosis of the right internal jugular vein associated with right parotitis. The literature is briefly reviewed.     

Salmonella neck abscess associated with jugular vein thrombosis.

An unusual case of synergistic infection caused by Salmonella paratyphi and anaerobic streptococcus resulting in necrotizing cervical infection associated with deep neck abscess and internal jugular vein thrombosis, is presented. Salmonella acting as an oxygen consumer in the infected tissues, facilitates the growth of anaerobic cocci, hence the development of a devastating soft tissue infection. The precipitating cause was a tonsillar infection developing due to 'post-anginal sepsis'. The aetiopathogenesis of the cervical infection is discussed.     

Internal jugular vein thrombosis due to ovarian hyper-stimulation syndrome

Internal jugular vein thrombosis from non-otological causes is not well documented in the otolaryngology literature. The authors report a case of left internal jugular vein thrombosis due to severe ovarian hyperstimulation syndrome. Causes, investigations and treatment of internal jugular vein thrombosis from non-otological causes are discussed.     

Internal jugular vein ectasia--a rare cause for paroxysmal cough

Internal jugular vein ectasia (dilatation of the internal jugular vein) is a rare clinical entity, often undiagnosed. Usually it presents as an asymptomatic, soft, compressible neck swelling that increases in size on Valsalva's manoeuvre. Our report describes right internal jugular vein ectasia in a 15-year-old girl who presented to us with intractable paroxysmal cough. The entity was suspected on ultrasound imaging and confirmed by computed tomography scan and Doppler. Ligation and excision of the dilated vein almost immediately cured her cough. The probable reason for the cough was the pressure exerted by the dilated vein on the vagus nerve.     

Internal jugular vein preservation in neck dissection for pN1-N2c oral and oropharyngeal carcinoma

PURPOSE: The aim of this study is to evaluate risk factors of neck recurrence in patients with pN1-N2 neck stage, submitted to a modified radical neck dissection with preservation of the internal jugular vein. MATERIALS AND METHODS: We reviewed the medical records of 72 patients with squamous cell carcinoma of the oral cavity (43 cases) and oropharynx (29 cases). The clinical stage of the neck was N1 in 23 cases and N2a-c in 49. RESULTS: Neck recurrences occurred in 6 cases at the side in which the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .391), T stage (P = .999), N stage (P = .203), adjuvant radiotherapy (P = .999), number of positive lymph nodes (P = .180), lymph nodes size (P = .429), and extracapsular spread (P = .400). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase on the risk of neck recurrence.     

Internal jugular phlebectasia

Varicose veins are a common venous anomaly, but rarer varieties also occur including phlebectasia, which is an abnormal dilatation of an isolated vein. Phlebectasia may affect any vein and is usually asymptomatic. When the internal jugular vein is involved, it presents as a cervical swelling that closely mimics the signs of either a pharyngocoele or a laryngocoele and, due to its rarity, is frequently misdiagnosed. A review of the English literature demonstrates that the diagnosis has generally been confirmed either by invasive contrast radiographic techniques, or surgical exploration, though many authors had made a tentative clinical diagnosis prior to surgical confirmation. No treatment is indicated for this benign self-limiting condition, except for the few patients who complain of symptoms and require surgical removal of the affected vein, and therefore, if a diagnosis cannot be made with certainty from the clinical features, investigations should be as non-invasive as possible, employing either a CAT scan or Digital Subtraction Angiography, though the latter is not yet universally available.     

Internal jugular vein erosion: An aggressive presentation of non-tuberculous mycobacterial lymphadenitis

We report the unusual case of a 2-year-old boy with non-tuberculous mycobacterial lymphadenitis that eroded into his internal jugular vein.During neck dissection, internal jugular vein erosion and mismatch in vessel width were noticed. Approximately 1 cm of internal jugular vein was resected and end-to-end anastomosis was performed. Four months later the patient had a relapse requiring a second operation.Despite the reported increased incidence of non-tuberculous mycobacterial lymphadenitis in immunocompetent patients, there are no other cases of internal jugular vein erosion reported in the literature. The approach in dealing with this condition is described.     

Internal jugular vein patency after lateral neck dissection: a prospective study

In spite of anatomical preservation of the internal jugular vein (IJV), an occlusion rate of the vessel of up to 30% has been documented after selective or modified radical neck dissections. The aim of the present prospective study was to evaluate the patency of the IJV following selective lateral neck dissection (LND) in 34 patients affected by squamous cell carcinoma of the upper aerodigestive tract who underwent surgery concomitantly on the primary site and the neck. Eighteen patients received unilateral and 16 bilateral LND, for a total of 50 IJVs. Postoperative radiotherapy on the neck was delivered in four patients with histologic evidence of micro-extracapsular spread; the impact of this variable on IJV patency was assessed by the Fisher test. A preoperative baseline study of vein patency and flow by ultrasonography (US) was obtained. Postoperative controls were scheduled at 1 week, 1 month and 3 months following surgery. No patient developed either wound infection or a pharyngocutaneous fistula, and no signs or symptoms of IJV occlusion were observed during the postoperative course. At the first US control, 25 IJVs (50%) did not present any alteration in patency, and 23 (46%) and 2 (4%) had a reduced or absent flow, respectively. At the second and third controls, 33 (66%) and 45 (90%) of the IJVs presented with normal flow, respectively. At the end of the study, none of the patients showed evidence of occlusion. Postoperative radiotherapy did not have a statistically significant impact on IJV patency ( P=0.09). In conclusion, long-term IJV occlusion after LND has to be considered an exceedingly rare event with negligible morbidity. However, alterations of IJV flow frequently occur in the immediate postoperative course.