You are here

Article Text

Article menu

Download PDFPDF

Spontaneous internal jugular vein thrombosis in rhabdomyosarcoma of the nasopharynx
Free
  1. Maia Walsh,
  2. Sheneen Meghji
  1. Mid Essex Hospital Trust, Chelmsford, Essex, UK
  1. Correspondence to Maia Walsh, maia.walsh{at}hotmail.com

https://doi.org/10.1136/bcr-2015-213455

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Description

    A 5-year-old child was referred to the ear, nose and throat team, with a left-sided quinsy following a 6-week history of progressive dysphagia and snoring. The child had been treated in the community with three courses of oral antibiotics, with minimal success. On presentation to hospital the child was afebrile and stertorous. Examination revealed a large left-sided oropharyngeal and soft palate swelling; there was no cervical lymphadenopathy. All inflammatory markers were within normal limits. A CT of the neck was requested for diagnosis of the mass.

    Contrast-enhanced CT of the neck and thorax revealed a large (8.3×3.8×5.2 cm) soft tissue density in the postnasal space. There was erosion of the left side of the clivus and an almost complete occlusive thrombus in the left internal jugular vein (IJV) (figures 1 and 2).

    Figure 1
    Figure 1

    Contrast-enhanced axial CT scan of the neck showing extension of the mass into the skull base and erosion of the left clivus (arrow).

    Figure 2
    Figure 2

    Contrast-enhanced axial CT scan of the neck showing the almost complete occlusive thrombus in the left internal jugular vein.

    Histology confirmed rhabdomyosarcoma, pretreatment stage 2, T2b, N0, M0, which is responding well to neo-adjuvant chemoradiotherapy. Staging is determined by the tumour site, size and metastases. Parameningeal sites including the nasopharynx are at risk of extension to the skull base resulting in poor surgical access and a less favourable prognosis.1 Spontaneous IJV thrombosis is described in malignancy and also in neck trauma from damage to the vessel.2

    Figure 1 is an example of a skull base extension in a nasopharyngeal rhabdomyosarcoma, highlighting the complications of parameningeal lesions. IJV thrombosis, showing in figure 2, is a recognised complication of malignancy but has not been described in the literature in rhabdomyosarcoma.3

    Learning points

    • Parameningeal rhabdomyosarcoma can extend to the skull base, impacting surgical accessibility and prognosis.

    • Spontaneous internal jugular vein thrombosis is a potential complication of nasopharyngeal rhabdomyosarcoma.

    References

    1. ↵
      1. Healy JN,
      2. Borg MF
      . Paediatric nasopharyngeal rhabdomyosarcoma: a case series and literature review. J Med Imaging Radiat Oncol 2010;54:388–94. doi:10.1111/j.1754-9485.2010.02187.x
      OpenUrlCrossRefPubMed
    2. ↵
      1. Pata YS,
      2. Unal M,
      3. Gülhan S
      . Internal jugular vein thrombosis due to distant malignancies: two case reports and literature review. J Laryngol Otol 2008;122:318–20. doi:10.1017/S0022215107008274
      OpenUrlPubMed
    3. ↵
      1. Shameem M,
      2. Akhtar J,
      3. Bhargava R, et al
      . Internal jugular vein thrombosis—a rare presentation of mediastinal lymphoma. Respir Med CME 2010;3:273–5. doi:10.1016/j.rmedc.2009.09.020
      OpenUrlCrossRef
    View Abstract

    Footnotes

    • Contributors MW identified the case and researched the relevant background information. The report was jointly written up and reviewed with SM.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.