Jugular Vein Thrombosis in a Patient Addicted to Intravenous Drugs

Navarrete Álvaro, María Luisa; Bonilla, David; Coscojuela, Pilar

doi:10.1016/j.otoeng.2013.02.002

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Classically, jugular thrombosis was mostly caused by cervical infections, such as pharyngotonsillitis, retropharyngeal abscesses, dental abscesses or mastoiditis. However, increased use of antibiotics in these aetiologies has reduced their incidence compared to the use of catheters or intravenous drug abuse. Currently, the diagnosis is made by computed tomography (CT) scans. CT scan images with contrast are characterised by a hypodense area in the vascular lumen, with an annular image of peripheral uptake usually appearing. The prognosis is poor.We report the case of a 31-year-old male with a history of infection by hepatitis C virus (HCV) and addiction to intravenous drugs. The patient attended the Emergency ENT Unit of our hospital due to right laterocervical swelling and pain along with fever, following injection of alprazolam in the right lateral region 2 days earlier.Upon physical examination, pharyngolaryngeal endoscopy was within normal limits and there was a puncture in the distal insertion of the right sternocleidomastoid where a non-fluctuating, inflammatory tumefaction could be felt. We requested analyses, which showed signs of systemic infection, and a cervical CT, which revealed right jugular vein thrombosis without collections. In the cranial axial projection we observed a filling defect in the start of the thrombosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and in the cervical coronal projection we noted an absence of contrast in the enlarged jugular, with inflammatory changes around it (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>A cervical axial reconstruction showed a complete absence of contrast enhancement in the jugular (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and in the end of the jugular thrombosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>A 3D reconstruction showed an absence of contrast in the cervical segment of the jugular (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>In conjunction with the internal medicine and vascular surgery service, we opted for intravenous treatment and observation, which the patient refused. Thus, he was discharged after being prescribed a treatment including antibiotics, analgesics, low molecular weight heparin and ambulatory monitoring." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Navarrete Álvaro ML, et al. Trombosis venosa yugular en paciente adicto a drogas por vía parenteral. Acta Otorrinolaringol Esp. 2013;64:83–84." ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 1501 "Tamanyo" => 119082 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 658 "Ancho" => 1501 "Tamanyo" => 117006 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 874 "Ancho" => 951 "Tamanyo" => 142589 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006400000001/v1_201304231504/S2173573513000045/v1_201304231504/en/main.assets" "Apartado" => array:4 [ "identificador" => "5869" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in otorhinolaryngology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006400000001/v1_201304231504/S2173573513000045/v1_201304231504/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573513000045?idApp=UINPBA00004N"]

ISSN: 2173-5735

Acta Otorrinolaringológica Española, the official publication of the Spanish Society of Otolaryngology and Head and Neck Surgery and the Ibero-American Society of Otorhinolaryngology, is the most important journal in Spanish dedicated to Otorhinolaryngology, which reflects the continuous scientific and technical progress of the specialty. It has become an important tool to be kept up to date. The Journal publishes Original Articles (articles on basic research and clinical investigation), reviews, brief communications, case studies and images, which are subjected to a rigorous peer review process.

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Vol. 64. Issue 1.