Internal jugular vein thrombosis in cervical spine trauma causing pulmonary embolism - a rare case report and review of the literature.

Abstract

To report an extremely rare occurrence of post-traumatic internal jugular vein (IJV) thrombosis leading to pulmonary embolism following cervical spine fracture dislocation. A 50-year-old healthy man with an AO type C C6-C7 fracture-dislocation and ASIA grade C quadriparesis underwent combined same-day posterior decompression-instrumentation and anterior cervical discectomy and fusion. On post-operative day 2, acute desaturation prompted CT pulmonary angiography, which demonstrated a saddle pulmonary embolism. Lower-limb venous ultrasound was negative for deep vein thrombosis. Pre-operative MRI and neck ultrasonogram revealed absence of left IJV flow indicating a post-traumatic thrombus serving as an occult embolic source. Progressive hemodynamic instability necessitated thrombolysis, prolonged mechanical ventilation, and tracheostomy. Follow-up ultrasonography at three weeks confirmed complete IJV recanalization. At six months, the patient was independently ambulant. Peri-vertebral venous injury may serve as a hidden source of thromboembolism in high-energy cervical spine trauma. Absence of IJV flow void on MRI should prompt focused vascular assessment. Early recognition and decisive multidisciplinary management can be lifesaving.