Superior mediastinal and internal jugular venous thrombosis presenting to the otolaryngologist

Venous thromboembolic disease has an estimated annual incidence of one in 1000 people. However, thrombosis of the superior mediastinum and neck veins is less frequent and it is usually due to direct trauma to the neck by intravenous catheters, drug abusers or neck dissection surgery. Local or distant malignancy (Trousseau's syndrome) is also an important cause. Thrombosis of the superior mediastinal and internal jugular veins is rarely a cause of primary referral to the otolaryngologist. On these rare occasions, it can present as a painful neck mass, but may also present with stridor, dysphonia or dysphagia. The four patients presented here illustrate different ways of presentation. Different imaging techniques such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) and venogram, will produce a diagnosis of thrombosis, occasionally with a mass, but only a biopsy will confirm or rule-out malignancy. Spontaneous thrombophlebitis can be the first manifestation of an occult neoplasm and any investigation into venous thrombosis must include a thorough general examination and follow up.