Jugular vein thrombosis is the formation of a blood clot in the jugular or jugular veins. The formation of a thrombus need not be associated with clotting disorders but may refer to malignancy or be the sign of a bacterial infection. Administration of heparin keeps the thrombus from growing further.
What is jugular venous thrombosis?
Thrombosis is a vascular disease. A blood clot, or thrombus, forms in blood vessels during this process. Thrombosis can affect any vessel in the body. Veins are most frequently affected by thrombus formation. This is also referred to as venous thrombosis or phlebothrombosis. Jugular vein thrombosis affects the jugular veins, also known as the internal, external and anterior jugular veins. These vessels are located in the head and neck region and exit the structure of the cranial cavity through the posterior portion of the jugular foramen. Jugular vein thrombosis usually involves unilateral thrombotic occlusion of the great jugular veins. The internal jugular vein is most commonly affected. The occlusive disease occurs comparatively rarely in the jugular veins and is characterized by extremely variable clinical course. In the past, the phenomenon carried a high risk of sepsis. In modern times, a septic course is rather the exception. Bacterial inflammation is no longer a common cause of jugular vein thrombosis since the introduction of antibiotics.
Causes
Thrombosis of the jugular veins may correspond to a complication of therapeutic interventions and thus often occurs, for example, with the placement of a central venous catheter or extensive neck procedures. In addition, space-occupying lesions such as tumors may obstruct the vein in some circumstances, leading to thrombus formation. Cervical inflammatory processes due to cervical phlegmon, in the setting of a peritonsillar abscess, or as a result of mastoiditis may also cause jugular vein thrombosis. Less commonly, thrombosis is the result of intravenous drug abuse with injections into the jugular veins. Far more common are causes such as blunt trauma to the neck or general coagulation disorders. Jugular vein thrombosis may also occur as a secondary presentation in the setting of pancreatic cancer, bronchial cancer, gastric cancer, or ovarian cancer.
Symptoms, complaints, and signs
The clinical presentation of jugular vein thrombosis is variable. Some patients develop a high-fever course. They complain of painful swelling of the neck on one side, which causes them to adopt a protective posture. This relieving posture can be secondary to tension and pain in the cervical spine. In some cases, thrombosis also causes dysphagia and voice disorders by pressing on the vocal cords, trachea or esophagus. Some patients are sensitive to pressure in the area of the vascular cord. Sepsis following thrombosis can occur in the setting of bacterial infectious thrombi, but is rare in modern times. Nonspecific signs of illness such as swelling of the neck, headache, or enlarged cervical lymph nodes are more common accompanying symptoms. In some circumstances, a derb consistent cord may be palpable in the course of the affected vein. In some cases, the so-called Queckenstedt sign is positive. In exceptional cases, jugular vein thrombosis does not cause any symptoms.
Diagnosis and course of the disease
In asymptomatic patients, jugular vein thrombosis is usually discovered as an incidental finding during sonographic examinations. Sonography is always the tool of choice for diagnosis. Imaging modalities such as CT or MRI may also allow a reliable diagnosis, but expose the patient to contrast material. Therefore, sonography should be given priority when thrombosis of the jugular veins is suspected. Laboratory chemistry may show an increase in D-dimers in patients. With infections, elevated infectious parameters such as C-reactive protein or leukocytosis are present. Thrombosis should be distinguished from degeneration of the lymph nodes. Malignant lymph nodes resemble a thrombotic venous occlusion at first glance, especially in axial slice images, and must be clearly excluded if the findings are appropriate. The prognosis of patients depends on the primary cause of thrombosis.
Complications
Jugular vein thrombosis may cause various symptoms and limitations in the daily life of the affected person.In most cases, however, patients suffer from a severe fever and a general feeling of illness. In addition, it is not uncommon for the patient to feel fatigued and their ability to cope with stress is significantly reduced and restricted by the jugular vein thrombosis. Furthermore, there is severe swelling in the neck area. The neck appears tense and there is pain in these regions. Not infrequently, the pain spreads from the neck area to other regions of the body and can cause discomfort there as well. Thus, headaches and, in the case of pain at rest, sleep disturbances continue to occur. The patient’s quality of life is considerably limited and reduced by the symptoms of jugular vein thrombosis. Similarly, sore throat may occur. Treatment of jugular vein thrombosis can be carried out with the help of medication and usually leads to a positive course of the disease. No particular complications occur. Life expectancy is also not reduced by this disease in most cases. The affected person may be dependent on taking blood thinners.
When should you see a doctor?
Swelling of the neck is an indication of irregularity that should be examined by a physician. If the symptoms persist or increase in intensity, a doctor should be consulted as soon as possible. Particular attention should be paid to changes in the neck when no colds are present. If irregularities can be palpated externally, they should be presented to a physician. Since jugular vein thrombosis can lead to premature death of the affected person if left untreated, timely medical examination is necessary to determine the cause. Tension in the cervical vertebrae that begins without a physical malposition is considered unusual. It is recommended to have them assessed by a doctor. If pain starts in the neck area or if there is a relieving posture of the head as well as the neck, these are warning signs that should be followed up. In the event of speech disorders, impaired breathing or peculiarities in the swallowing process, a visit to the doctor is advisable. If food intake is refused due to swallowing difficulties or if there is a reduced fluid intake, the organism may become undersupplied in the further course. A visit to the doctor is necessary as soon as a feeling of internal dryness sets in or there is severe weight loss. Otherwise, dehydration can lead to a life-threatening condition. Lymphatic swelling, a dull sensation when hearing, or headaches should also be fully evaluated by a physician.
Treatment and therapy
In principle, treatment of jugular vein thrombosis always depends on the underlying disease or cause of thrombus formation. Causal therapeutic administration of heparin is always indicated in cases of hypercoagulability. To rule out complications such as sepsis in the case of a bacterial infectious cause, certain antibiotics are administered depending on the particular pathogen. Intraluminal lysis therapies are usually not performed, as they in particular increase the risk of sepsis. When sepsis is imminent or has already set in, this phenomenon is the main focus of treatment. Thus, with sepsis in extreme cases, surgically invasive ligation or even partial or total resection of the affected vein may become necessary. In cases of causative coagulation disorders, treatment of thrombosis is usually much easier with the administration of anticoagulant heparin preparations. Once the growth of the thrombus is stopped, the body can begin the cleanup work and break down the clot. Artificially induced thrombolysis has not usually been used since recent times to dissolve thrombi in the veins. This is because of the risk of bleeding that occurs within veins during thrombolysis.
Outlook and prognosis
Jugular vein thrombosis has an unfavorable course without medical treatment. This disorder results in the formation of blood clots in the area of the neck as well as the head. If the affected person does not seek medical attention as well as medical care, the thrombus is expected to grow. As a result, existing symptoms gradually increase in intensity and, over time, new irregularities appear, leading to a decrease in well-being.In addition to headaches, dysphagia and swelling, there is a general decrease in quality of life. Fulfilling daily responsibilities becomes increasingly difficult and complications may occur. When medical care is sought, the thrombus is removed in an operation. This is associated with the usual risks and side effects. If the intervention proceeds without further complications, the blood circulation is regulated and the health impairments are alleviated. In many patients, freedom from symptoms can be documented shortly after the removal of the thrombus. Despite an achieved recovery, there is a possibility of recurrence in this disease. Recurrence is possible at any time during life. The prognosis is unchanged in the event of a recurrence of jugular vein thrombosis. The sooner the condition is diagnosed and treated, the better and faster relief from symptoms can occur.
Prevention
Patients with increased blood clotting due to excessively thick blood, in particular, can prevent thrombus formation by taking certain medications for a long time. Blood-thinning medications based on acetylsalicylic acid or ASA are sometimes used for this purpose. There are also various home remedies for blood thinning, such as ginger, nuts, avocado and pomegranate. The use of home remedies in no case replaces medical advice or medical drug treatment, but should be used with appropriate indication at most in combination with medication.
Aftercare
Measures of direct aftercare are severely limited in most cases of jugular venous thrombosis. In this regard, the affected person should ideally contact a medical professional at an early stage so that no further complications or discomfort occur in the affected person, since this disease cannot heal on its own. The earlier a doctor is consulted, the better the further course of the jugular vein thrombosis usually is. In most cases, this disease is treated by taking various medications. In any case, the affected person should ensure that the medication is taken regularly and in the correct dosage in order to permanently alleviate the symptoms. A doctor should always be consulted first if there is any uncertainty or if there are any questions. Likewise, regular examinations by a doctor are very important in this disease. In case of heavy bleeding or injuries, a doctor should be consulted. In many cases, patients with this disease are dependent on the help and also the support of their own family or friends. In this regard, loving and intensive conversations are also useful, as this can also prevent psychological discomfort or depression.
This is what you can do yourself
In most cases, there are no self-help options available to the patient with jugular vein thrombosis. In any case, medical treatment is necessary for this condition to prevent further complications. Since the affected person is often dependent on taking antibiotics for this disease, possible interactions with other medications should be taken into account here. It is advisable to inform the doctor about other medications taken in order to avoid these interactions. Likewise, alcohol consumption should be strictly avoided when taking antibiotics. In order to avoid the formation of thrombi in general, the affected person should take blood-thinning medication in case of known pre-existing conditions. Various foods are also available to the affected person, such as avocado, ginger, nuts or pomegranate. Nevertheless, sufferers are dependent on taking heparin to inhibit blood clotting. Frequently, contact with other sufferers also helps, as this leads to an exchange of information, which can make the patient’s daily life easier. If psychological complaints arise, discussions with one’s own friends or relatives are very helpful.
