Successful treatment of superior vena cava syndrome due to internal jugular vein thrombosis in a 55-year-old man with comorbid diabetes mellitus type 2 and pneumonia

Rezdy Tofan; Shinta Oktya Wardhani; Arif Rahman Nurdianto

doi:10.15562/bmj.v12i2.4538

Successful treatment of superior vena cava syndrome due to internal jugular vein thrombosis in a 55-year-old man with comorbid diabetes mellitus type 2 and pneumonia

Rezdy Tofan ,

Shinta Oktya Wardhani ,

Arif Rahman Nurdianto ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4538 |
Published: 2023-05-31

Abstract

Link of Video Abstract: https://youtu.be/FZsJ7mtGsW8

Introduction: Superior vena cava syndrome (SVCS) associated with jugular internal vein thrombosis can be dangerous. Diagnosing SVCS and venous thromboembolism (VTE) must be done precisely and accurately to minimize the risk of pulmonary embolism.

Case Presentation: Male, 55 years old, complaining of shortness of breath, the feeling of choking in the neck, and a lump in the neck for one month. The patient has a history of type 2 diabetes mellitus and does not routinely take medication. The patient experienced tachypnea and tachycardia, and there was an enlargement in the submental to the submandibular region; the boundaries were not firm, supple, or fixed, approximately ten centimeters in diameter, and the collateral veins were enlarged and felt pain. Chest examination revealed telangiectasia, crackles, and bronchovesicular breath sounds over both lungs at the base and medial side. The patient had mild anemia and leukocytosis, increased HbA1c levels, total cholesterol levels, and increased D-dimer and Lactate dehydrogenase (LDH). Antero-posterior (AP) lateral cervical radiograph shows a widening of the soft tissue in the retro tracheal space at the level of the second cervix. The patient given warfarin, enoxaparin, methylprednisolone, and heparin. Improvement of the condition was shown.

Conclusion: Superior vena cava syndrome due to internal jugular vein thrombosis is a challenging case. Careful diagnostic measurement based on history and physical examination, in addition of additional investigation may lead to the diagnosis. Management with warfarin, enoxaparin, methylprednisolone, and heparin show clinical benefit.

References

Kumar V, Abbas AK, Fausto N, Robbins SL, Cotran RS. Robbins and Cotran Pathologic Basis of Disease. Philadelphia, PA, USA: Elsevier Saunders; 1984.
Gbaguidi X, Janvresse A, Benichou J, Cailleux N, Lévesque H, Marie I. Internal jugular vein thrombosis: outcome and risk factors. QJM Int. J. Med. 2010;104:209–219.
Leci-Tahiri L, Zherka-Saracini H, Tahiri A, Koshi A. Bilateral internal jugular vein thrombosis due to malignant tumor. J. Med. Case Rep. 2018;12:42.
Hindi Z, Fadhel E. Idiopathic bilateral external jugular vein thrombosis. Am. J. Case Rep. 2015;16:554–557.
Uzun K, Erkoc R, Yuca K, Etlik O, Do ˘gan E, Sayarlıoglu H, et al. Internal jugular vein thrombosis two different etiologies. Electron. J. Gen. Med. 2005;2:123–128.
Bandara AR, Wimalarathna H, Kalupahana R, Gunathilake SSC. Internal jugular venous thrombosis due to Trousseau’s syndrome as the presenting feature of metastatic prostate carcinoma: a case report. J. Med. Case Rep. 2016;10:104.
Shameem M, Akhtar J, Bhargava R, Ahmed Z, Baneen U, Khan NA. Internal jugular vein thrombosis—A rare presentation of mediastinal lymphoma. Respir. Med. CME. 2010;3:273–275.
Haider MS, Master MF, Atluri S, Nfonoyim J. Superior vena cava syndrome due to thrombosis: a case report. Cureus. 2022;14(5):1–8.
Anderson DR, O'Brien BJ, Levine MN, Roberts R, Wells PS, Hirsh J. Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Ann Intern Med. 1993;119(11):1105-1112.
Setiabudy R. Hemostasis dan Trombosis. Jakarta: Balai Penerbit Fakultas Kedokteran Universitas Indonesia; 2007. p. 34.
Fisherman AP. Fishman's Pulmonary Diseases and Disorders: Pulmonary Thromboembolic Disease. Fourth Edition. Pennsylvania: Medicine University of Pennsylvania Medical Center, Philadelphia; 2008. p. 1425-1433.
Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL. Harrison’s Principles of Internal Medicine. Eighteenth Edition. The McGraw-Hill Companies, Inc; 2012. p. 117
Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Wang H, Berr SS, et al. Multifactorial determinants of functional capacity in peripheral arterial disease. Journal of the American College of Cardiology. 2009;54(7):628-634.
Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part II. Treatment and prevention. Am Fam Physician. 2004;69(12):2841-2848.
Gaspard KJ. Disorders of Hemostasis. Pathophysiology: Concepts of Altered Health States. Seventh Edition. Lippincott Williams & Wilkins; 2004. p. 15.
Pineo GF, Hull RD, Raskop G. Respiratory Critical Care: Pulmonary Embolism and Pulmonary Hypertension. London: Guy's and St Thomas Hospital Trust and GKT School of Medicine, London, UK; 2002. p. 249-260.
Ginsberg, J. Deep Venous Thrombosis. In Cecil Medicine. 23rd edition. Goldman L (eds). New York: McGraw-Hill; 2007.
Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M, et al. Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients. World J Emerg Surg. 2016;11:24.
Stevens SM, Fazili M, Woller SC. Choosing ultrasound technique for suspected deep vein thrombosis: which is best?. Quant Imaging Med Surg. 2020;10(6):1418-1421.
Chappell FM, Andras A, Welch K, Di Nisio M, Robertson L, Stewart M, et al. D‐Dimer tests for the diagnosis of deep venous thrombosis in symptomatic hospital outpatients with a clinical prediction rule. Cochrane Database Syst Rev. 2016;2016(9):CD012356.
Kassaï B, Boissel JP, Cucherat M, Sonie S, Shah NR, Leizorovicz A. A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients. Thromb Haemost. 2004;91(4):655-666.
Sampson FC, Goodacre SW, Thomas SM, van Beek EJ. The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis. Eur Radiol. 2007;17(1):175-181.
Sujana KY, Semadi IN, Mahadewa TGB. The correlation of Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio compared to D-dimer as a diagnostic test in Deep Vein Thrombosis (DVT). Bali Med J. 2020;9(2):546-552.
Gatot D, Lindarto D, Mardia AI. Incidence of deep vein thrombosis in patients with diabetic foot ulcers. Bali Med J. 2019;8(2):642-645.
Nurtyas FIP, Giantini A. Deep vein thrombosis (DVT) in ovarian clear cell carcinoma with liver metastasis: a case report. Bali Med J. 2019;8(2):385-389.
Rogers FB, Mark DC, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. The Journal of Trauma: Injury, Infection, and Critical Care. 2002;53(1):142-164.
Weitz JI, Hirsh J, Samama MM. New antithrombotic drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):234S-256S.