Jugular Vein Thrombosis

  • Nicholas A. Koontz
  • Richard H. WigginsIII
  • Lubdha M. Shah
Reference work entry


Jugular vein thrombosis (JVT) is a not uncommon and serious finding encountered by radiologists. While identifying thrombus within the internal jugular vein (IJV) is usually not a diagnostic dilemma, a thorough evaluation of the surrounding structures is critical due to the sundry etiologies, potentially devastating complications (including pulmonary embolism, septic emboli, and dural sinus thrombosis), and high association with neoplasm. In this chapter, we discuss the typical anatomy of the IJV and the pathophysiology, clinical presentation, and potential etiologies of JVT (including iatrogenic, neoplastic, infectious, traumatic, hematologic, rheumatologic, gynecologic, endocrine, and idiopathic causes, as well as pediatric-specific considerations). Multimodality imaging findings of JVT (computed tomography, magnetic resonance imaging, ultrasound, nuclear medicine, and angiography) and the diagnostic pitfalls are also reviewed, utilizing an image-rich, comprehensive review of the medical literature.


CT MRI Vascular venous imaging Jugular vein 


  1. 1.
    Valecchi D, Bacci D, Gulisano M et al (2010) Internal jugular vein valves: an assessment of prevalence, morphology and competence by color Doppler echography in 240 healthy subjects. Ital J Anat Embryol 115(3):185–189PubMedGoogle Scholar
  2. 2.
    Malcom GE, Raio CC, Poordabbagh AP, Chiricolo GC (2008) Difficult central line placement due to variant internal jugular vein anatomy. J Emerg Med 35:189–191CrossRefPubMedGoogle Scholar
  3. 3.
    Dickson BC (2004) Venous thrombosis: on the history of Virchow’s triad. Univ Tor Med J 81(3):166–171Google Scholar
  4. 4.
    Pata YS, Ünal M, Gülhan S (2008) Internal jugular vein thrombosis due to distant malignancies: two case reports and literature review. J Laryngol Otol 122:318–320CrossRefPubMedGoogle Scholar
  5. 5.
    Gisolf J, van Lieshout JJ, van Heusden K, Pott F, Stok WJ, Karemaker JM (2004) Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol 560(Pt 1):317–327PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Volturo GA, Repeta RJ (2001) Non-lower extremity deep vein thrombosis. Emerg Med Clin North Am 19(4):877–893CrossRefPubMedGoogle Scholar
  7. 7.
    Gbaguidi X, Janvresse A, Benicou J, Cailleux N, Levesque H, Marie I (2011) Internal jugular vein thrombosis: outcome and risk factors. Q J Med 104:209–219CrossRefGoogle Scholar
  8. 8.
    Yardim H, Erkoc R, Soyoral YU, Begenik H, Avcu S (2012) Assessment of internal jugular vein thrombosis due to central venous catheter in hemodialysis patients: a retrospective and prospective serial evaluation with ultrasonography. Clin Appl Thromb Hemost 18(6):662–665CrossRefPubMedGoogle Scholar
  9. 9.
    Arhi CS, Buchanan MA, Allen SA, Pickles J (2010) Internal jugular vein thrombosis secondary to a permanent cardiac pacemaker: an unusual case of lateral neck swelling. J Laryngol Otol 124:916–918CrossRefPubMedGoogle Scholar
  10. 10.
    Yurtseven T, Erşahin Y, Kitiş Ö, Mutluer S (2005) Thrombosis and thrombophlebitis of the internal jugular vein as a very rare complication of ventriculoatrial shunt. Clin Neurol Neurosurg 107:144–146CrossRefPubMedGoogle Scholar
  11. 11.
    Agraharkar M, Isaacson S, Mendelssohn D et al (1995) Percutaneously inserted silastic jugular hemodialysis catheters seldom cause jugular vein thrombosis. ASAIO J 41(2):169–172CrossRefPubMedGoogle Scholar
  12. 12.
    Harada H, Omura K, Takeuchi Y (2003) Patency and caliber of the internal jugular vein after neck dissection. Auris Nasus Larynx 30:269–272CrossRefPubMedGoogle Scholar
  13. 13.
    Sheikh MA, Topoulos AP, Deitcher SR (2002) Isolated internal jugular vein thrombosis: risk factors and natural history. Vasc Med 7:177–179CrossRefPubMedGoogle Scholar
  14. 14.
    Vormittag R, Simanek R, Ay C et al (2009) High factor VIII levels independently predict venous thromboembolism in cancer patients. Arterioscler Thromb Vasc Biol 29:2176–2181CrossRefPubMedGoogle Scholar
  15. 15.
    Kanz R, Vukovich T, Vormittag R et al (2011) Thrombosis risk and survival in cancer patients with elevated C-reactive protein. J Thromb Haemost 9:57–63CrossRefPubMedGoogle Scholar
  16. 16.
    Cheang PP, Fryer J, Ayoub O, Singh V (2004) Spontaneous bilateral internal jugular vein thrombosis: a sign of metastasis. J Laryngol Otol 118:570–572CrossRefPubMedGoogle Scholar
  17. 17.
    Chen M-H, Chang PM-H, Chen P-M et al (2010) Prolonged facial edema is an indicator of poor prognosis in patients with head and neck squamous cell carcinoma. Support Care Cancer 18:1313–1319CrossRefPubMedGoogle Scholar
  18. 18.
    Veras E, Srodon M, Neijstrom ES, Ronnett BM (2009) Metastatic HPV-related cervical adenocarcinomas presenting with thromboembolic events (Trousseau syndrome): clinicopathologic characteristics of 2 cases. Int J Gynecol Cancer 28:134–139CrossRefGoogle Scholar
  19. 19.
    Lin D, Reeck JB, Murr AH (2004) Internal jugular vein thrombosis and deep neck infection from intravenous drug use: management strategy. Laryngoscope 114:56–60CrossRefPubMedGoogle Scholar
  20. 20.
    Karkos PD, Asrani S, Karkos CD et al (2009) Lemierre’s syndrome: a systematic review. Laryngoscope 119:1552–1559CrossRefPubMedGoogle Scholar
  21. 21.
    Wright WF, Shiner CN, Ribes JA (2012) Lemierre syndrome. South Med J 105(5):283–288CrossRefPubMedGoogle Scholar
  22. 22.
    Chirinos JA, Lichtenstein DM, Garcia J, Tamariz LJ (2002) The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine 81(6):458–465CrossRefPubMedGoogle Scholar
  23. 23.
    O’Brien WT, Lattin GE, Thompson AK (2006) Lemierre syndrome: an all-but-forgotten disease. AJR Am J Roentgenol 187:W324CrossRefPubMedGoogle Scholar
  24. 24.
    Duke BJ, Ryu RK, Brega KE, Coldwell DM (1997) Traumatic bilateral jugular vein thrombosis: case report and review of the literature. Neurosurgery 41(3):680–683PubMedGoogle Scholar
  25. 25.
    Caplan JM, Kalpey Z, Gates J (2008) Closed traumatic head injury: dural sinus and internal jugular vein thrombosis. Emerg Med J 25(11):777–778CrossRefPubMedGoogle Scholar
  26. 26.
    Mnejja M, Hammami B, Bougacha L et al (2011) Internal jugular vein thrombosis by protein C activated resistance. Eur Ann Otorhinolaryngol Head Neck Dis 128:269–271CrossRefPubMedGoogle Scholar
  27. 27.
    Provenzale JM, Ortel TL, Allen NB (1998) Systemic thrombosis in patients with antiphospholipid antibodies: lesion distribution and imaging findings. AJR Am J Roentgenol 170:285–290CrossRefPubMedGoogle Scholar
  28. 28.
    Misita CP, Moll S (2005) Antiphospholipid antibodies. Circulation 112:e39–e44CrossRefPubMedGoogle Scholar
  29. 29.
    Danaci M, Akpolat T, Koyuncu M, Unal R, Belet U (2000) The advantages of MRI and MRA for diagnosing Behçet’s disease and internal jugular vein thrombosis. Comput Med Imaging Graph 24:121–124CrossRefPubMedGoogle Scholar
  30. 30.
    Chan WS, Ginsberg JS (2006) A review of upper extremity deep vein thrombosis in pregnancy: unmasking the ‘ART’ behind the clot. J Thromb Haemost 4:1673–1677CrossRefPubMedGoogle Scholar
  31. 31.
    Fleming T, Sacks G, Nasser J (2012) Internal jugular vein thrombosis following ovarian hyperstimulation syndrome. Aust N Z J Obstet Gynaecol 52:87–90CrossRefPubMedGoogle Scholar
  32. 32.
    Arya R, Shehata HA, Patel RK et al (2001) Internal jugular vein thrombosis after assisted conception therapy. Br J Haematol 115:153–155CrossRefPubMedGoogle Scholar
  33. 33.
    Stuijver DJF, van Zaane B, Feelders RA et al (2011) Incidence of venous thromboembolism in patients with Cushing’s syndrome: a multicenter cohort study. J Clin Endocrinol Metab 96:3525–3532CrossRefPubMedGoogle Scholar
  34. 34.
    Panzironi G, Rainaldi R, Ricci F, Casale A, Macciucca MDV (2003) Gray-scale and color Doppler findings in bilateral internal jugular vein thrombosis caused by anaplastic carcinoma of the thyroid. J Clin Ultrasound 31(2):111–115CrossRefPubMedGoogle Scholar
  35. 35.
    Yoshimura M, Kawamato A, Kakasone K et al (2003) Gallium-67 accumulation to the tumor thrombus in anaplastic thyroid cancer. Ann Nucl Med 17(8):689–691CrossRefPubMedGoogle Scholar
  36. 36.
    Mugunthan N, Kumar AR, Thomas P (2010) Tumor thrombus in the great veins from papillary carcinoma of the thyroid: 131-I scan findings. J Clin Endocrinol Metab 95:2527–2528CrossRefPubMedGoogle Scholar
  37. 37.
    Hanslik A, THom K, Haumer M et al (2008) Incidence and diagnosis of thrombosis in children with short-term central venous lines of the upper venous system. Pediatrics 122:1284–1291CrossRefPubMedGoogle Scholar
  38. 38.
    Male C, Kuhle S, Mitchell L (2003) Diagnosis of venous thromboembolism in children. Semin Thromb Hemost 29:377–390CrossRefPubMedGoogle Scholar
  39. 39.
    Khosa F, Otero HJ, Prevedello LM, Rybicki FJ, Di Salvo DN (2010) Imaging presentation of venous thrombosis in patients with cancer. AJR Am J Roentgenol 194:1099–1108CrossRefPubMedGoogle Scholar
  40. 40.
    Taillefer R (2001) Radiolabeled peptides in the detection of deep venous thrombosis. Semin Nucl Med 31(2):102–123CrossRefPubMedGoogle Scholar
  41. 41.
    Bates SM, Lister-James J, Julian JA, Taillefer R, Moyer BR, Ginsberg JS (2003) Imaging characteristics of a novel technetium Tc 99m-labeled platelet glycoprotein IIb/IIIa receptor antagonist in patients with acute deep vein thrombosis or a history of deep vein thrombosis. Arch Intern Med 163:452–456CrossRefPubMedGoogle Scholar
  42. 42.
    Kikuchi M, Yamamoto E, Shiomi Y, Kikuchi M, Yamamoto E, Shiomi Y et al (2004) Internal and external jugular vein thrombosis with marked accumulation with FDG. Br J Radiol 77:888–890CrossRefPubMedGoogle Scholar
  43. 43.
    Sopov V, Bernstine H, Stern D, Yefremov N, Sosna J, Groshar D (2009) The metabolic spectrum of venous thrombotic disorders found on PET/CT. AJR Am J Roentgenol 193:W530–W539CrossRefPubMedGoogle Scholar
  44. 44.
    Chang R, Horne MK, Mayo DJ, Doppman JL (1996) Pulse-spray treatment of subclavian and jugular venous thrombi with recombinant tissue plasminogen activator. J Vasc Interv Radiol 7(6):845–851CrossRefPubMedGoogle Scholar
  45. 45.
    Tajima H, Murata S, Kumazaki T, Ichikawa K, Tajiri T, Yamamoto Y (2004) Successful interventional treatment of acute internal jugular vein thrombosis. AJR Am J Roentgenol 182:467–469CrossRefPubMedGoogle Scholar
  46. 46.
    Provenzale JM, Kranz PG (2011) Dural sinus thrombosis: sources of error in image interpretation. AJR Am J Roentgenol 196(1):23–31CrossRefPubMedGoogle Scholar
  47. 47.
    Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF (2011) Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am J Neuroradiol 32:1354–1357CrossRefPubMedGoogle Scholar
  48. 48.
    Besachio DA, Quigley EP 3rd, Shah LM, Salzman KL (2013) Noncontrast computed tomographic Hounsfield unit evaluation of cerebral venous thrombosis: a quantitative evaluation. Neuroradiology 55(8):941–945CrossRefPubMedGoogle Scholar
  49. 49.
    Takhtani D (2005) CT neuroangiography: a glance at the common pitfalls and their prevention. AJR Am J Roentgenol 185:772–783CrossRefPubMedGoogle Scholar
  50. 50.
    Ayanzen RH, Bird CR, Keller PJ, McCully FJ, Theobald MR, Heiserman JE (2000) Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol 21(1):74–78PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nicholas A. Koontz
    • 1
  • Richard H. WigginsIII
    • 1
  • Lubdha M. Shah
    • 1
  1. 1.Department of RadiologyUniversity of Utah Health Sciences CenterSalt Lake CityUSA

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