Spontaneous internal jugular vein thrombosis associated with distant malignancies.

Internal jugular vein (IJV) thrombosis is an extremely rare vascular disease that is easily overlooked or misdiagnosed. It is usually secondary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies, either known or occult, are also uncommon and not well documented in the etiology of IJV thrombosis. A previously healthy, 48-year-old man presented to our Ear, Nose and Throat (ENT) Department with pain and swelling of the right side of the neck, which had been going on for a period of 9 days, with the absence of any other ENT symptoms. Examination of his neck showed swelling and tenderness along the anterior border of the right sternocleidomastoid muscle. An ultrasound scan of the neck confirmed right IJV thrombosis. Further investigation to determine the cause for the thrombosis revealed two coincidental malignancies: prostate and lung. This shows that every patient with spontaneous thrombophlebitis must undergo a careful history, a complete physical examination and a thorough investigation to avoid missing or delaying the diagnosis of a hidden malignancy.