P51 | Unilateral internal jugular vein thrombosis as presentation of malignancy: case report

Premises: Internal jugular vein thrombosis (IJVT) is a rare site of venous thrombosis. IJVT could be divided into primary and secondary (80%) thrombosis, most frequently associated to central venous catheterization and malignancy. IJVT generally presents with pain and swelling of the neck, but it may also be asymptomatic.Description of the Case report: A 54-years-old man presented with painful swelling over the right side of the neck, associated with fever. His clinical history included only smoking habit. The patient had sinus tachycardia. Chest examination evidenced harsh murmur. Laboratory exams revealed increased indices of inflammation and D-dimer 4770 ng/mL. Neck ultrasound showed complete right IJVT and malignant supraclavicular lymph nodes. Analgesic therapy, ceftriaxone and enoxaparin 8000 IU b.i.d. were started. Whole-body CT demonstrated nodular lesion of the right upper lung lobe in junction with the pleura, mediastinal and right hilar lymph node packages, pulmonary embolism of basal segments, colliqued splenic lesion, pelvic osteolytic areas. Mediastinal lymph node biopsy was performed by videothoracoscopy, whose histological examination led to the diagnosis of metastatic poorly differentiated lung carcinoma. The patient was referred to the oncology department for further management.Conclusions: IJVT may constitute the clinical onset of local or metastatic tumor (most frequently lung and ovarian cancer, lymphoma). Cancer-associated IJVT leads to high morbidity related to pulmonary embolism and post-thrombotic syndrome and requires anticoagulation treatment.