What to know about jugular vein thrombosis

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Some of the symptoms of JVT include:

• Swelling and tenderness: The jugular vein may enlarge and feel firm to the touch. The swelling is likely due to the blood clot obstructing blood flow.
• Pain or discomfort in the neck, especially when turning the head: The presence of a clot can cause pain or discomfort in the neck area. Movements that involve turning or bending the neck may exacerbate this pain.
• Redness and warmth: Sometimes, the skin over the affected jugular vein may appear red and feel warm to the touch. This is a result of inflammation caused by the clot.
• Difficulty swallowing or speaking: If the blood clot is large or in certain locations, it may put pressure on adjacent structures, such as the esophagus or larynx. This pressure can lead to difficulty swallowing — dysphagia — or speaking — dysphonia.
• Headaches and visual disturbances: In more severe instances of JVT, the blood clot may extend into the intracranial veins or sinuses. This can cause increased intracranial pressure, leading to headaches and, sometimes, visual disturbances.

There are a variety of reasons someone may develop JVT, including:

• Prolonged use of central venous catheters: Central venous catheters are long, thin tubes inserted into a large vein, often in the neck, chest, or groin, to deliver medication, fluids, or nutrients directly into the bloodstream. Prolonged use of these catheters can lead to the formation of blood clots, including in the jugular vein.
• Trauma: Trauma, such as a direct injury to the neck or surrounding tissues, can cause damage to the blood vessels, leading to clot formation.
• Certain infections of the throat or neck: For example, Lemierre’s syndrome. This rare, and potentially severe, condition typically starts with an infection in the throat, usually caused by bacteria, such as Fusobacterium necrophorum. The infection can spread to the nearby jugular vein, causing a clot to form.
• Hypercoagulable conditions: Some people have a higher risk of developing blood clots due to underlying hypercoagulable conditions or clotting disorders. Hypercoagulable conditions may be genetic or acquired and can increase the likelihood of clot formation in the jugular vein.
• Cancer: Cancer can promote a prothrombotic — clot-promoting — state in the body, increasing the risk of blood clot formation. In head and neck cancers, the tumors may compress or invade blood vessels, contributing to clot formation in the jugular vein.

A thorough physical examination, medical history review, and imaging studies are essential for diagnosing jugular vein thrombosis.

Doctors commonly use the following imaging techniques to detect a blood clot:

• Doppler ultrasound, a special type of ultrasound that allows doctors to identify blood clots
• X-rays, usually of the veins, known as venography
• CT scans
• MRI scans

Laboratory tests, such as D-dimer blood tests, can also provide helpful details.

The main treatments for JVT are the following:

Anticoagulant medications

Anticoagulants, or blood thinners, can help prevent the existing blood clot from growing any larger and reduce the risk of new clots forming. Common anticoagulants include heparin and warfarin. Heparin is usually given intravenously or through an intramuscular injection. Warfarin, however, is an oral medication, usually for longer-term management.

Doctors may also prescribe newer oral anticoagulants, such as:

• apixaban
• rivaroxaban
• dabigatran
• edoxaban

The choice of medication will depend on the person’s specific situation and medical history.

Thrombolysis

In people with a clot that is extensive or causes severe symptoms, doctors may recommend thrombolysis. Thrombolysis involves administering medications, known as thrombolytics, that actively dissolve the blood clot.

This treatment is generally more aggressive than standard anticoagulation, and doctors usually administer it in a hospital setting for close monitoring.

The overall outlook depends on various factors, including:

• the person’s age
• rapid intervention
• the underlying cause
• the individual’s health status

Still, with proper care, the prognosis is generally positive. However, some research suggests that the mortality rate for people with JVT is around 44%.

JVT can lead to various complications, some of which can be severe and life threatening. These can include:

• Pulmonary embolism: This is where a blood clot breaks loose from the jugular vein and travels to the lungs. This can be life threatening and requires immediate medical intervention.
• Infection: If an infection causes the thrombosis, it can spread from the original infection site to the bloodstream, leading to a severe and potentially life threatening condition known as septicemia or sepsis.
• Septic emboli: A septic embolus can form when infected material travels through the bloodstream, causing abscesses or infections in distant organs.
• Stroke or intracranial complications: If the clot extends into the intracranial veins or sinuses, it can increase intracranial pressure and potentially lead to a stroke or other complications.
• Post-thrombotic syndrome: This condition can cause chronic pain, swelling, and skin changes in an affected limb.
• Recurrent thrombosis: Some people may be at an increased risk of developing new blood clots after experiencing JVT, especially if they have underlying clotting disorders or other risk factors.
• Compression of nearby structures: Sometimes, the clot can compress nearby structures in the neck, leading to difficulties with swallowing, speaking, or breathing.
• Chronic venous insufficiency: Prolonged obstruction of the jugular vein can make it difficult for the blood to return to the heart from the head and neck. This can cause persistent swelling, discomfort, and skin changes.

However, complications are rare if a doctor diagnoses and treats JVT quickly.

Although rare, jugular vein thrombosis can occur when blood clots form in one of the jugular veins. Causes of JVT are broad and can include infection, trauma, or cancer. Having blood clotting disorders can increase a person’s risk of developing JVT.

Seeking immediate medical attention if someone exhibits symptoms suggestive of JVT is essential for ensuring the best possible outcome. Symptoms include neck pain, swelling, and tenderness.

A prompt diagnosis and appropriate treatment are crucial to preventing life threatening complications, such as a pulmonary embolism. Treatment usually involves anticoagulation therapy or, in more severe instances, thrombolysis.