Acute pulmonary emboli due to internal jugular vein thrombosis in papillary thyroid carcinoma, a case report and literature review
A 75-year-old woman with a three month history of dyspnea on exertion (DOE), weight loss and anorexia was referred to the clinic of pulmonary disease. There were no other symptoms. Her medical history had no problem. On admission temperature was 37°C, pulse rate was 85/min, respiratory rate 14/min and blood pressure was 140/90mm/Hg, jugular vein pressure (JVP) was normal and there was no neck and arm swelling. A right-sided cervical adenopathy with suspected thyroid nodule was detected. Other examinations were normal.\nChest X-ray was normal, erythrocyte sedimentation rate (ESR) was 70/hour, other routine laboratory tests were normal. Echocardiography was normal. Sonography revealed cervical adenopathy of the right side and thyroid nodule with the dimensions of 0.8 mm × 0. 6 mm.\nOne day after admission, sudden dyspnea was occurred with PR: 125/min, RR: 30/min, BP: 85/50mm/Hg and o2 saturation: 70%. A decreased sound was detected in both lungs. Chest X-ray showed a bilateral pleural effusion. Pleural tap was exudative, CT spiral showed bilateral pulmonary emboli with plural effusion and lung collapse []. She was treated with streptokinase. CT scan of the neck showed a right-sided cervical adenopathy, heterogeneous thyroid and internal jugular vein thrombosis concomitant with superior thyroid vein thrombosis []. Thyroid FNA revealed papillary thyroid carcinoma []. The day after thrombolytic therapy her respiratory distress became better that showed thrombotic nature of emboli.\nFinally total thyroidectomy was performed, histopathological examination revealed papillary thyroid carcinoma with lymph node involvement. Microscopic examination showed neoplastic proliferation of epithelial cell with papillary appearance, the cells include round to oval nuclei with ground glass foci. Doppler ultrasonographic examination of the subclavian, axillary and brachycephalic vein was normal. After total thyroidectomy, she was treated with the diagnosis of secondary IJVT due to PTC with enoxaparin and Warfarin, after 5 days warfarin continued.