Payrard Loïc, Iten Léa, Donzé Jacques, John Gregor
Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland.
Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland.
Thromb J. 2021 Jan 6;19(1):2. doi: 10.1186/s12959-020-00246-7.
Managing thrombosis in rare sites is challenging. Existing studies and guidelines provide detailed explanations on how to overcome lower-limb thromboses and pulmonary embolisms, but few studies have examined thrombosis in rare sites. Lack of data makes clinical practice heterogeneous. Recommendations for diagnosing, treating, and following-up internal jugular vein thrombosis are not clearly defined and mostly based on adapted guidelines for lower-limb thrombosis.
A 52-year-old Caucasian woman came to the Emergency Department with chest, neck, and left arm pain. Computed tomography imagery showed a left internal jugular vein thrombosis. An extensive workup revealed a heterozygous factor V Leiden gene. Therapy was initiated with intravenous unfractionated heparin, then switched to oral acenocoumarol, which resolved the symptoms. Based on this case presentation and a literature review, we summarize the causes, treatment options, and prognosis of unprovoked internal jugular vein thrombosis.
Managing internal jugular vein thrombosis lacks scientific data from large randomized clinical trials, partly because such thromboses are rare. Our literature review suggested that clinical treatments for internal jugular vein thrombosis often followed recommendations for treating lower-limb thrombosis. Future specific studies are required to guide clinicians on the modalities of diagnosis, screening for thrombophilia or oncologic disease, treatment duration, and follow-up.
处理罕见部位的血栓形成具有挑战性。现有研究和指南对如何克服下肢血栓形成和肺栓塞提供了详细解释，但很少有研究探讨罕见部位的血栓形成。数据的缺乏使得临床实践存在异质性。关于诊断、治疗和随访颈内静脉血栓形成的建议尚未明确界定，且大多基于适用于下肢血栓形成的指南。
一名52岁的白种女性因胸部、颈部和左臂疼痛来到急诊科。计算机断层扫描图像显示左侧颈内静脉血栓形成。全面检查发现存在杂合子因子V莱顿基因。治疗开始时使用静脉普通肝素，随后改用口服醋硝香豆素，症状得以缓解。基于该病例报告和文献综述，我们总结了不明原因颈内静脉血栓形成的病因、治疗选择和预后。
处理颈内静脉血栓形成缺乏大型随机临床试验的科学数据，部分原因是此类血栓形成较为罕见。我们的文献综述表明，颈内静脉血栓形成的临床治疗通常遵循下肢血栓形成的治疗建议。未来需要进行具体研究，以指导临床医生进行诊断方式、血栓形成倾向或肿瘤疾病筛查、治疗持续时间和随访等方面的工作。
