Symptoms of Occlusive Internal Jugular Vein Thrombosis
Patients with occlusive internal jugular (IJ) vein thrombosis most commonly present with neck pain and swelling, often accompanied by a palpable cord beneath the sternocleidomastoid muscle, with or without fever. 1
Primary Clinical Manifestations
The clinical presentation of IJ thrombosis can range from subtle to dramatic, with the following key features:
Local Neck Symptoms
- Painful neck swelling is the hallmark presentation, typically unilateral and localized along the anterior border of the sternocleidomastoid muscle 2, 3, 4
- Palpable cord sign - a firm, tender cord-like structure beneath the sternocleidomastoid muscle, representing the thrombosed vein 1
- Erythema overlying the affected area 1
- Tenderness along the course of the internal jugular vein 4
Systemic and Associated Symptoms
- Headache is frequently reported and may be severe 1
- Fever commonly accompanies IJ thrombosis, particularly when associated with infection 2, 1
- Facial or neck edema may extend beyond the immediate area, potentially involving the face, head, or supraclavicular space 5
Critical Diagnostic Considerations
A high index of suspicion is essential because the clinical presentation may be vague, misleading, or even completely asymptomatic. 2 Some patients present with absolutely no symptoms despite having significant thrombosis 2.
Warning Signs of Complications
When evaluating IJ thrombosis, clinicians must remain vigilant for signs of potentially life-threatening complications:
- Superior vena cava syndrome signs: facial swelling, prominent neck veins, cyanosis, and upper extremity edema 5
- Catheter dysfunction if a central venous catheter is present 5
- Neurological symptoms suggesting intracranial propagation or septic emboli 2
- Respiratory symptoms suggesting pulmonary embolism 2, 1
Context-Dependent Presentations
The symptom profile may vary based on underlying etiology:
Infection-Related Thrombosis
When IJ thrombosis occurs secondary to deep neck space infection (Lemierre syndrome), patients typically present with:
- Constitutional symptoms including fever and malaise 2
- Signs of the primary infection (pharyngitis, dental infection) 2
- More acute onset of symptoms 2
Malignancy-Associated Thrombosis
In cases associated with occult or known malignancy:
- Presentation may be more insidious 4
- Symptoms may be less dramatic initially 4
- Any spontaneous IJ thrombosis warrants thorough malignancy workup 4
Catheter-Related Thrombosis
For catheter-associated IJ thrombosis:
- Symptoms may include catheter malfunction (sluggish blood return, difficulty flushing) 5
- Swelling typically develops on the ipsilateral side of catheter placement 5
- May be completely asymptomatic and discovered incidentally 5
Common Diagnostic Pitfalls
The most critical pitfall is dismissing vague neck symptoms or attributing them to more common benign conditions. 2 The diagnosis is frequently delayed or missed entirely because:
- Symptoms can mimic lymphadenitis, muscle strain, or other benign neck conditions 2
- Complete absence of symptoms occurs in some cases 2
- Presentation overlaps with many other conditions 1
Any patient presenting with unilateral neck pain and swelling, particularly with risk factors such as recent infection, malignancy, central venous catheterization, or hypercoagulable states, should undergo immediate duplex ultrasound evaluation. 2, 3, 1