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62-Year-Old Female with Gastric Cancer, Neck Swelling
This case features a 62-year-old female with known gastric cancer presenting with neck swelling, ultimately diagnosed with thrombophlebitis of the internal jugular vein (IJV).
Imaging overview:
Axial, sagittal, and coronal contrast-enhanced CT of the neck demonstrates a filling defect within the right IJV consistent with thrombosis, with surrounding soft tissue inflammation confirming thrombophlebitis. A right IJV central line is visible, consistent with the patient’s history of chemotherapy administration.
Clinical insight:
IJV thrombophlebitis is characterized by thrombosis combined with inflammation of the vessel wall and surrounding soft tissues. The combination of an intraluminal filling defect and perivenous inflammatory change on contrast-enhanced CT is diagnostic. Etiology follows the Virchow triad: endothelial damage (from indwelling lines or intravenous drug use), altered blood flow or venous stasis, and hypercoagulable state. In oncology patients receiving chemotherapy via central venous access, indwelling line-related endothelial injury and hypercoagulability from malignancy both contribute to thrombophlebitis risk. Recognition of perivenous inflammation as a distinguishing feature from bland thrombosis alone is important for guiding treatment.
Case courtesy of Daniel E. Meltzer, MD, Mount Sinai Hospital System, NYC.