Internal jugular vein thrombosis and deep neck infection from intravenous drug use: Management strategy
Internal jugular vein thrombosis and deep neck infection from intravenous drug use: Management strategy
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DOI：
10.1097/00005537-200401000-00009
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发表时间：
2004-01-01
期刊：
影响因子：
2.6
通讯作者：
Murr, AH
中科院分区：
文献类型：
--
作者：
Lin, D;Reeck, JB;Murr, AH
目的：颈内静脉血栓形成（IJVT）表现在多种临床情况下，包括创伤，肿瘤和感染过程。对于颈深部感染情况下的IJVT，目前尚无明确的治疗方案。本研究探讨了静脉注射毒品（IVDU）引起的深颈感染中IJVT的原因、诊断和治疗策略。研究设计：方法：回顾性分析11例IVDU患者的临床、影像学和实验室资料，包括颈部深部感染和IJVT。患者在大学三级护理机构就诊。结果：11例患者的深颈部感染，最近的历史，静脉输液器，并发IJVT的确定。所有患者均接受计算机断层扫描（CT）。所有病例均采用抗生素治疗，穿刺抽吸或切开引流进行侵入性治疗，无静脉结扎或切除。3例患者接受抗凝治疗。1例患者发生双侧IJVT，血栓通过乙状窦延伸至侧窦。该患者接受抗凝治疗并发生菌血症。在平均14个月的干预后，没有进一步的IJVT并发症被诊断出来。结论：即使在抗生素治疗的现代，IVDU引起的IJVT和颈部深部感染也构成了一个临床实体。建议对颈部深部感染进行积极的抗生素治疗和手术干预。抗凝治疗的适应症仍存在差异。尽管在血栓进展或脓毒性栓塞的情况下通常建议抗凝治疗，但IJVT的存在并不要求抗凝治疗。血栓静脉的结扎或切除术可用于选择性病例，但在我们的病例中并不必要。
Objective: Internal jugular vein thrombosis (IJVT) manifests in multiple clinical scenarios including traumatic, neoplastic, and infectious processes. No clear management algorithm exists for IJVT in the setting of deep neck infections. This study examines the cause, diagnosis, and treatment strategy for IJVT in the setting of deep neck infections caused by intravenous drug use (IVDU). Study Design: Retrospective chart review Methods: The clinical, radiographic, and laboratory data of 11 IVDU patients with deep neck infections and IJVT are reviewed in a retrospective fashion. The patients were seen in a university tertiary care facility. Results: Eleven patients with deep neck infections, recent history of IVDU, and concurrent IJVT were identified. All patients underwent computed tomography (CT) scanning. Antibiotic therapy was instituted in all cases, abscesses were treated invasively with aspiration or incision and drainage, and no veins were ligated or resected. Three patients received anticoagulation. One patient had bilateral IJVT with thrombus extension through the sigmoid sinus to the lateral sinus. This patient received anticoagulation and developed bacteremia. No further IJVT complications have been diagnosed at an average of 14 months postintervention. Conclusion: IJVT and deep neck infection caused by IVDU constitute a clinical entity present even in the modern day era of antibiotic therapy. Aggressive antibiotic therapy and surgical intervention for the deep neck infection is recommended. The indications for anticoagulation remain variable. Although anticoagulation is often recommended in the presence of thrombus progression or septic emboli, the very presence of IJVT does not mandate the need for anticoagulation. Ligation or resection of the thrombosed vein may be reserved for selected cases, but was not necessary in our series.