Need for an Urgent Ultrasound Examination for Neck Lump

Abstract

Thromboembolic phenomenon is rare but serious consequence of ovarian hyperstimulation syndrome (OHSS) and in vitro fertilization (IVF) treatment. We present a case of thrombosis of the right internal jugular vein presenting as a neck lump to the ENT department. Ultrasonography of the neck and upper extremity revealed thrombosis of right internal jugular vein. The patient was started on low molecular weight heparin, which resulted in resolution of her clinical condition. Interestingly, the majority of cases after OHSS involve thrombosis of the upper extremities. ENT surgeons, general physicians, and infertility experts should consider this in the differential diagnosis of neck swellings, particularly after OHSS and IVF treatment, and in this case report, we emphasis the need for an urgent ultrasound of the neck in such patients.

Internal Jugular Venous Thrombosis After in Vitro Fertilization

“…This is in contrast with the general population, in whom isolated spontaneous IJDVT is virtually unheard of. In this latter group, isolated IJDVT is usually found in intravenous drug users, and this accounts for 60% of the cases (1,2,8,9). Consequently, it seems that IVF alone or in conjunction with OHSS is a risk factor for IJDVT.…”

“…The entity is uncommon and the history may be only that of neck pain, with or without swelling, and IVF. Examination may only show some neck fullness or mass, and at times, distended collateral veins may be seen (5,8). Laboratory investigations also may be entirely normal.…”

“…Laboratory investigations also may be entirely normal. The diagnostic modality of choice is duplex vascular ultrasound, and this tool may not be available for EPs at all hours of the day (1,8,11).…”

Evidence Based Management of Spontaneous Internal Jugular Vein Thrombosis: A Literature Review

“…This is one of the reasons why this is now rarely used as a first line investigation. Ultrasound scan is a quick, non-invasive investigation and is used frequently in the management of several described case reports [4,9]. Doppler U/S is a sensitive and safe imaging technique with the ability to demonstrate the loss of respiratory rhythm within the vein which has been shown to be useful in both diagnosis and follow up [10].…”

“…Warfarin cannot be administered to pregnant woman because teratogenicity [27]. Low molecular weight heparin is used to prevent and treat thrombus formation because it does not cross the placenta [28] and treatment is advised to continue for the entire length of pregnancy [9]. Ball et al [12] recommended treating patients with Factor V Leiden deficiency with intravenous heparin followed by long-term warfarin maintaining the INR between 2.5 and 3.0.…”