Imaging Pearls ❯ Neuroradiology ❯ Vascular
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- “ Nonspontaneous internal jugular vein thrombosis is an uncommon condition that historically has been associated with deep neck infections, such as Lemierre syndrome, during the preantibiotic era. Today, trauma to the internal jugular vein from catheterization and repeated IV injections by drug users are the leading causes of thrombosis.”
Successful Interventional Treatment of Acute Internal Jugular Vein Thrombosis
Tajima H et al.
AJR 2004;182:467-469 - “ Nonspontaneous internal jugular vein thrombosis is an uncommon condition that historically has been associated with deep neck infections, such as Lemierre syndrome, during the preantibiotic era. Today, trauma to the internal jugular vein from catheterization and repeated IV injections by drug users are the leading causes of thrombosis.”
Successful Interventional Treatment of Acute Internal Jugular Vein Thrombosis
Tajima H et al.
AJR 2004;182:467-469 - “ Deep venous thrombosis (DVT) involving the upper extremities, chest, and neck has become appreciated as a significant cause of morbidity, especially in individuals with central venous access devices (CVAD). Like DVT involving the leg and pelvic veins, axillo-subclavian vein thrombosis can result in pulmonary embolism, post-thrombotic syndrome, and venous limb gangrene.”
Isolated internal jugular vein thrombosis: risk factors and natural history.
Sheikh MA et al.
Vasc Med. 2002 Aug;7(3):177-9. - “Lemierre syndrome is a rare clinical entity, with fewer than 160 cases reported since it was first described in the early 1900s . This syndrome consists of internal jugular vein thrombosis after a primary oropharyngeal infection with the development of distant septic emboli . The lungs are most often affected; however, almost any organ may be involved.”
Lemierre Syndrome: An All-But-Forgotten Disease
William T. O'Brien, et al.
AJR 2006;187: W324-W324. - “Classically, Lemierre syndrome occurs in otherwise healthy adolescents and young adults. Appropriate diagnosis is often delayed because of the initial indolent course of the infection and the relative obscurity of the disease. The diagnosis is made with positive blood cultures, usually F. necrophorum, and appropriate imaging findings. Often, imaging findings precede blood culture results; therefore, radiologists play a crucial role in the early recognition of this syndrome. Prompt diagnosis and treatment are necessary to prevent sepsis and subsequent death.”
Lemierre Syndrome: An All-But-Forgotten Disease
William T. O'Brien, et al.
AJR 2006;187: W324-W324.
- “Originally thought to be a rare occurrence, blunt cerebrovascular injuries (BCVIs) are now diagnosed in approximately 1% of blunt trauma patients. Early imaging of patients has resulted in the diagnosis of BCVIs during the asymptomatic phase, thus allowing prompt treatment. Although the ideal regimen of antithrombotic therapy has yet to be determined, treatment with either antiplatelet agents or anticoagulation has been shown to markedly reduce BCVI-related stroke rate. BCVIs are rare, potentially devastating injuries; appropriate imaging in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.”
Imaging for blunt carotid and vertebral artery injuries
Burlew CC, Biffi WL
Surg Clin North Am 2011 Feb;91(1)217-31 - “The incidence of "indirect" cervical arterial injuries with craniofacial gunshot wounds is comparable to or slightly higher than those seen in pure blunt trauma. Screening patients with craniofacial gunshot injuries with CT angiography may yield unexpected cervical vascular injuries remote from the penetrating tract.”
Craniofacial gunshot injuries: an unrecognized risk factor for blunt cervical vascular injuries
Steenburg SD, Silker CE
Eur Radiol 2012 Sep;22(9):1837-43 - “Originally thought to be a rare occurrence, blunt cerebrovascular injuries (BCVIs) are now diagnosed in approximately 1% of blunt trauma patients. Early imaging of patients has resulted in the diagnosis of BCVIs during the asymptomatic phase, thus allowing prompt treatment. Although the ideal regimen of antithrombotic therapy has yet to be determined, treatment with either antiplatelet agents or anticoagulation has been shown to markedly reduce BCVI-related stroke rate. BCVIs are rare, potentially devastating injuries; appropriate imaging in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.”
Imaging for blunt carotid and vertebral artery injuries
Burlew CC, Biffi WL
Surg Clin North Am 2011 Feb;91(1)217-31 - “Contrast material-enhanced helical computed tomographic (CT) angiography is increasingly being used to evaluate trauma patients in stable condition who are at risk for vascular injuries. It allows characterization of traumatic vascular lesions in the neck such as partial or complete occlusion, pseudoaneurysm, intimal flap, dissection, and arteriovenous fistula. In the same setting, CT angiography provides valuable additional information about the cervical soft tissues, aerodigestive tract, spinal canal, and spinal cord.”
Vascular injuries of the neck and thoracic inlet :helical CT-angiographic correlation
Nunez DB Jr et al.
Radiographics 2004. July-Aug 24(4);1087-98 - “CT angiography may be limited by artifacts from metallic fragments and occasionally by abundant soft-tissue air or streak artifacts in the shoulders. In such cases, conventional angiography is necessary for optimal assessment of vascular injuries. CT angiography can be used as a noninvasive alternative to conventional angiography in patients suspected to have vascular injuries but without initial indications for surgical treatment.”
Vascular injuries of the neck and thoracic inlet :helical CT-angiographic correlation
Nunez DB Jr et al.
Radiographics 2004. July-Aug 24(4);1087-98
- Jugular Vein Thrombosis: CT Findings
- Dilated vein
- Enhancement of vessel wall
- Central thrombosis of the vein
- Adjacent soft tissue swelling - Jugular Vein Thrombosis: Facts
Patients present with - Fever
- Leukocytosis
- Cervical pain
- Mass or neck swelling
- Sepsis - Jugular Vein Thrombosis: Etiology
- Central line placement
- Local infection or abscess
- Extension by tumor
- Trauma
- Hypercoagability states
- Drug abuse (IV access)