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1 Department of General Surgery, BJGMC & SGH, Pune, Maharashtra 2 Final Year Student, BJGMC & SGH, Pune, Maharashtra +91-8108370966, Email: soniyabaral11@gmail.com 3 Department of General Surgery, BJGMC & SGH, Pune, Maharashtra +91-9823013042 Email: dr.sst@hotmail.com Corresponding Author Amol Mittal Department of General Surgery, BJGMC & Sassoon General Hospital, Pune-411001 Maharashtra India +91-8007771705, Email: amollucymittal@gmail.com Abstract Background: A 44-year-old female came to tertiary care hospital with complaints of swelling present in neck region on left side along with discharging fluid since last 1month. The swelling was tender, fluctuant, non-pulsatile, non-reducible in nature. It was associated with local rise of temperature and associated with discharge. Patient received seven-day course of an antibiotic (Amoxycillin-clavulanic acid) at local place without relief. Patient was vitally stable with oxygen saturation of 98 percent on room air. USG showed well-defined, heterogeneous, predominantly hypo-echoic conglomerated lymph nodes in cervical region at level II largest measuring 3.4*3*4.2 cm with necrotic material within it. The visualized left Internal Juglar Vein showed echogenic material with absent colour flow suggestive of left side IJV thrombosis (Fig 1). Methods & Results: Ultrasound-guided fine-needle aspiration cytology of the cervical node was performed, which showed caseous necrosis and epitheloid granuloma, with acid-fast bacilli being positive. Patient was started on Anti-tubercular drug after the diagnosis was made. Subsequently patient was started on LMWH for the underlying IJV thrombosis with the warfarin cover and PT-INR monitoring. Discussion: IJV thrombosis is a serious entity with a potentially fatal outcome. Its complications could include pulmonary embolism and sepsis as well as intracranial propagation of the thrombus. The thrombogenic potential of tuberculosis is not well known however it has been postulated to be a hypercoagulable state that appears to develop secondary to the acute phase response. Knowledge about IJV thrombosis secondary to tubercular cervical lymphadenopathy among general surgeonsis quintessential as the presentation can easily be mistaken for neck abscess, treatment is not standardized and the incidence of occurrence is rare.

IJV Thrombosis in a case of Tubercular Cervical Lymphadenopathy