PMC6000736_01
Picture of the patient's neck showing left-sided swelling without notable cellulitis changes in the overlying skin.
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Local examination of the neck revealed normal skin appearance with a soft, tender, non-pulsatile swelling in the left anterior triangle (Fig. 1), and a palpable cord-like structure at the anterior margin of left sternocleidomastoid muscle.
Colour flow Doppler ultrasound of the neck showing a large echogenic thrombus in the left internal jugular vein (red arrow).
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An urgent colour flow Doppler (CFD) ultrasound of the neck revealed a non-compressible and completely thrombosed left IJV as shown in Fig. 2, but no underlying neck collection was found.
Computed tomographic scan (axial view) of the neck showing a large filling defect completely obstructing the left internal jugular vein (Asterisk).
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A computed tomographic (CT) scan with intravenous (IV) contrast confirmed the findings of suppurative thrombophlebitis of the left IJV, Fig. 3.
Computed tomographic scan (coronal view) of the thoracic outlet showing extension of the thrombus to the left subclavian (red arrow) and brachiocephalic veins, surrounded by fat stranding indicating an inflammatory process. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Another CT scan with contrast demonstrated extension of the thrombus to the mediastinum with involvement of the left subclavian vein, Fig. 4.