![]() The tunneled catheter entered via the right subclavian vein near the junction of the right IJV with its tip located in the lower superior vena cava ( Figure 3). A CT pulmonary angiogram was performed in the ED that confirmed the ultrasound exam showing that the right IJV was distended with a thrombus ( Figure 2). The patient was referred to the ED, and her hematologist/oncologist was informed of her admission. There were no abnormal masses or nodes seen in the bilateral levels II, III, IV, V and VI of the neck. The right IJV had no blood flow along the entire length within the neck, but the right subclavian vein had flow by Doppler before the junction with the right IJV to form the right innominate vein ( Figure 3B). Blood flow in the left IJV and bilateral carotid arteries (CA) is normal. The axial view of the neck shows an enlarged right internal jugular vein (IJV) without blood flow (red arrow) with collateral blood flow resulting in increased flow in the right anterior but not the left anterior jugular vein (blue arrows). The left IJV contained a heterogeneous soft tissue with no blood flow by Doppler analysis ( Figure 1A) while the diameter of the right IJV was normal with good blood flow ( Figure 1C vs. Of note, the right thyroid lobe was compressed by an enlarged right interval jugular vein (IJV) and more posterior in position compared with the left lobe in the transverse view ( Figure 1A vs. This nodule did not reach the size threshold for biopsy per the 2015 American Thyroid Association guideline, and the patient was informed that watchful waiting without biopsy was recommended. Lee, MD, PhD, ECNU Ultrasound, CT imagingĪn office thyroid ultrasound was performed that showed a thyroid of normal size with an isoechoic nodule with an indistinct border in the left lobe that measured 0.9 cm x 0.8 cm x 0.8 cm (sagittal x anterioposterior x transverse) without microcalcifications or intranodular vascular flow by Doppler ( Figure 1B). Images reprinted with permission from: Stephanie L. Abbreviations: CA = carotid artery N = nodule THY = thyroid. (C) Right internal jugular vein (IJV) with Doppler. Her thyroid function was normal, with thyroid-stimulating hormone 3.65 uIU/mL, free thyroxine index 2.2 and thyroid peroxidase antibody less than 10 IU/mL. ![]() Her family history was negative for thyroid disease, including thyroid cancer. She had no prior history of head and neck radiation. She had noted swelling under her right chin in the past few days, but reported no food or pill dysphagia, cough, dyspnea or stridor. The patient had recently been discharged from the hospital on warfarin anticoagulation for a blood clot in her right upper extremity. The patient had a tunneled catheter placed in the right subclavian vein for venous access. The patient had been diagnosed 1 year before with stage II estrogen receptor–positive/progesterone receptor–positive, HER-2–negative invasive ductal carcinoma of the left breast metastatic to the axillary nodes. LeeĪ 43-year-old woman was referred to the endocrine clinic for a thyroid nodule found on a CT scan of the chest during the evaluation of breast cancer. If you continue to have this issue please contact to Healio Stephanie L.
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