Clinical Case 13

10 Oct

A 26 year old man presented with a 6 month history of weight loss night sweats and swelling to the neck and anterior chest.

Right external jugular veins were distended on assessment.

POCUS was used to evaluate a swelling of the right stermocleidomastoid and internal jugular vein.

Describe the image

There is evident soft tissue mass and thrombus with the right IJV with abnormal dilatation of the vessel and retrograde flow

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What is this known as?

Tumour thrombus.

Tumour thrombus is usually composed of a soft tissue component and a thrombotic component.

In this case it is seen within the right internal jugular vein.

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What relevance does this have?

Presence and nature of any tumour thrombus is important for determining theĀ TNM stage.

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What is the further management and how did POCUS affect initial management?

Establishing the diagnosis of underlying malignancy. In this case CT and lymph node biopsy confirmed an aggressive lymphoma. Therapeutic anticoagulation (rather than prophylactic) was commenced on viewing the tumour thrombus in ED.

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