Diagnosis of internal jugular vein thrombosis.

Six patients, aged 14-83 years, were shown by computed tomography (CT) to have thromboses of the internal jugular vein. In all cases, medical attention was sought only after a delay (4-21 days). In no case was the provisional clinical diagnosis correct, with working diagnoses ranging from abscess to neoplasm. A wide variety of likely causes was discovered, including venous catheters, local malignancy, infective cervical adenopathy, and polycythemia. CT showed distended veins with enhancing walls, low-attenuation intraluminal filling defects, and swelling of the adjacent soft tissues. Four of the six patients also underwent ultrasound examinations, which showed the veins to be distended and nonpulsatile, with internal echoes. Both modalities proved reliable and accurate. Because of the subtle and often non-specific clinical findings, it is likely that more clinically unsuspected cases will be encountered by the radiologist.