Internal jugular vein thrombosis and deep neck infection from intravenous drug use: management strategy.

OBJECTIVE: Internal jugular vein thrombosis (IJVT) manifests in multiple clinical scenarios including traumatic, neoplastic, and infectious processes. No clear management algorithm exists for IJVT in the setting of deep neck infections. This study examines the cause, diagnosis, and treatment strategy for IJVT in the setting of deep neck infections caused by intravenous drug use (IVDU). STUDY
DESIGN: Retrospective chart review.
METHODS: The clinical, radiographic, and laboratory data of 11 IVDU patients with deep neck infections and IJVT are reviewed in a retrospective fashion. The patients were seen in a university tertiary care facility.
RESULTS: Eleven patients with deep neck infections, recent history of IVDU, and concurrent IJVT were identified. All patients underwent computed tomography (CT) scanning. Antibiotic therapy was instituted in all cases, abscesses were treated invasively with aspiration or incision and drainage, and no veins were ligated or resected. Three patients received anticoagulation. One patient had bilateral IJVT with thrombus extension through the sigmoid sinus to the lateral sinus. This patient received anticoagulation and developed bacteremia. No further IJVT complications have been diagnosed at an average of 14 months postintervention.
CONCLUSION: IJVT and deep neck infection caused by IVDU constitute a clinical entity present even in the modern day era of antibiotic therapy. Aggressive antibiotic therapy and surgical intervention for the deep neck infection is recommended. The indications for anticoagulation remain variable. Although anticoagulation is often recommended in the presence of thrombus progression or septic emboli, the very presence of IJVT does not mandate the need for anticoagulation. Ligation or resection of the thrombosed vein may be reserved for selected cases, but was not necessary in our series.