Acute pulmonary emboli due to internal jugular vein thrombosis in papillary thyroid carcinoma, a case report and literature review


1 Department of Internal Medicine, School of Medicine, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran


Upper extremity deep vein thrombosis (UEDVT) is a life threatening rare condition. Among the patients with UEDVT, internal jugular vein is accepted as uncommon thrombosis. Since internal jugular vein thrombosis (IJVT) is mostly underdiagnosed, a great attention is needed to diagnose the disease. A 75-year-old woman with history of dyspnea on exertion (DOE), weight loss and anorexia with the stable vital sign and right-sided cervical adenopathy with suspected thyroid nodule was admitted. One day after admission, sudden dyspnea was occurring with unstable vital sign and hypotension. Chest X-ray showed a bilateral pleural effusion. Pleural tap was exudative, CT scan showed bilateral pulmonary emboli. CT scan of the neck showed right-sided cervical adenopathy, heterogeneous thyroid and internal jugular vein thrombosis concomitant with superior thyroid vein thrombosis. The patient was treated with thrombolytic agent and enoxaparin followed by warfarin. Thyroid FNA revealed papillary thyroid carcinoma that followed by total thyroidectomy, histopathological examination verified papillary thyroid carcinoma. Although lower extremity DVT is the main cause of pulmonary emboli, but IJVT may be proceed by pulmonary embolism. Due to fatal outcome of pulmonary emboli in IJVT, color duplex sonography, is recommended in documented tumors or suspected history of malignancy.


1. Boedeker CC, Ridder GJ, Weerda N, Maier W, Klenzner T, Schipper J. [Etiology and therapy of the internal jugular vein thrombosis]. Laryngorhinootologie 2004;83:743-9.  Back to cited text no. 1
2. Gbaguidi X, Janvresse A, Benichou J, Cailleux N, Levesque H, Marie I. Internal Jugular vein thrombosis: Outcome and risk factors. QJM 2011;104:209-19.  Back to cited text no. 2
3. Sheikh MA, Topoulos AP, Deitcher SR. Isolated internal jugular vein thrombosis: Risk factors and natural history. Vasc MED 2002;7:177-9.  Back to cited text no. 3
4. Togashi Y, Kim YH, Masago K, Tamai K, Sakamori Y, Mio T, et al. Pulmonary embolism due to internal jugular vein thrombosis in a patient with non-small cell lung cancer receiving bevacizumab. Int J Clin Oncol 2011;16:444-6.  Back to cited text no. 4
5. Erkoc R, Uzun k, Yuca K, Etlik O, Dogan A.Internal jugular vein thrombosis two different etiologies. Eur J Gen Med 2005;2:123-8.  Back to cited text no. 5
6. Lee JA, Zierler BK, Zierler RE. The risk factors and clinical outcomes of upper extremity deep vein thrombosis. Vasc Endovascular Surg 2012;46:139-44.  Back to cited text no. 6
7. Carrington BM, Adams JE. Jugular vein thrombosis associated with distant malignancy. Postgrad Med J 1988;64:455-8.   Back to cited text no. 7
8. Bick RL. Cancer-associated thrombosis. N Engl J Med 2003;349:109-11.  Back to cited text no. 8