Septic thrombophlebitis of the internal jugular and subclavian veins treated with percutaneous mechanical thrombolysis

Abstract

Introduction: Treatment of septic thrombophlebitis of the jugular vein may include both medical and surgical interventions. Historically, the goal of surgical interventions was not the restoration of blood flow through the affected vessel. Case presentation: We present a case of a 19-year-old male with septic thrombophlebitis who, despite appropriate antibiotic treatment, experienced symptomatic thrombus progression. Percutaneous thrombolytic procedures were performed, successfully restoring blood flow without triggering clinically significant bacteraemia or septic emboli. Conclusion: Thrombolysis may have a role in select patients, especially those with co-existent thrombophilia or progressive thrombus development despite medical treatment.

Lemierre’s syndrome: a pain in the neck with far-reaching consequences

“…This gives rise to two possibilities: breakdown of the clot could theoretically release septic emboli implying anticoagulation could worsen prognosis17 or alternatively earlier breakdown of the clot as a consequence of anticoagulation could permit better antibiotic penetration and faster resolution. There are case reports describing the use of mechanical thrombolysis in the treatment of Lemierre’s syndrome and such treatment has not resulted in further septic emboli 19. Case reports in which anticoagulation therapy has been started following non-resolution with antibiotic therapy do demonstrate an improvement in patient condition following anticoagulant administration but it is impossible to determine whether this is solely due to the addition of an anticoagulant agent 17…”