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Introduction
Venous thromboembolic disease has an estimated annual incidence in developed countries of one in 1000 people. The disorder commonly affects the legs, but may occur in other veins. The veins in the head and neck, even in the presence of localised disease, appear to be less susceptible to thrombosis, as they are mostly valveless and gravity aids their emptying in the upright position.1,2
Although less common than lower extremity deep vein thrombosis (DVT), the incidence of DVT involving the upper extremities may be increasing and accounts for approximately 4 per cent of all DVTs. The most common predisposing factor is the presence of a central venous catheter, which is present in up to 75 per cent of patients with upper extremity DVT.3 The presence of local or distant malignancy is an important aetiological factor which should be considered.1 The association of cancer and thrombophlebitis was first observed by Trousseau, and this association still bears his name. The incidence of thrombophlebitis in cancer patients is quite common, and migratory thrombophlebitis is well documented.3
Venous thrombosis results from a disturbance of the normal blood flow, with subsequent activation of the coagulation mechanism. The pathophysiology of venous thrombosis is well described in Virchow's triad for vascular thrombosis, which requires the presence of one or more of the following factors: endothelial damage, alteration of blood flow and blood hypercoagulability. Activated clotting factors collect in areas of sluggish or turbulent blood flow, thereby precipitating platelet aggregation. This in turn initiates the thrombotic process.4
The internal jugular vein (IJV) is an uncommon site of spontaneous venous thrombosis. Most cases usually result from intravenous drug abuse, jugular vein catheterisation, neck dissection, a hypercoagulable state associated with malignancy, neck injury or ovarian overstimulation syndrome.4
In this paper, we present and discuss two cases of spontaneous jugular vein thrombosis, associated with breast and lung malignancies.
Case one
A 58-year-old woman presented with an approximately three-month history of a painful swelling on the left posterior triangle of the neck (Figure 1). Past medical history was unremarkable. The patient was a non-smoker.
Fig. 1
Swelling and discoloration on the left posterior...