J Korean Neurosurg Soc.  2013 Mar;53(3):183-186. 10.3340/jkns.2013.53.3.183.

Fatal Septic Internal Jugular Vein-Sigmoid Sinus Thrombosis Associated with a Malpositioned Central Venous Catheter

• Seung WB
• Kim DY
• Kim JW
• Park YS

• KMID: 2190758
• DOI: http://doi.org/10.3340/jkns.2013.53.3.183

Abstract

Septic internal jugular vein-sigmoid sinus thrombosis (IJV-SST) associated with a malpositioned central venous catheter is a rare condition. It is potentially life-threatening and necessitates early diagnosis and rapid administration of appropriate medications. Unfortunately, it is difficult to diagnose due to vague clinical presentations. Several studies such as CT, MRI, and cerebral angiography should be performed and carefully examined to help make the diagnosis. We report a case of septic IJV-SST due to a malpositioned central venous catheter.

Keyword

Central venous catheter; Internal jugular vein; Sigmoid sinus; Thrombosis

MeSH Terms

Central Venous Catheters
Cerebral Angiography
Early Diagnosis
Sinus Thrombosis, Intracranial
Thrombosis

Figure

• 

  Fig. 1 A 52-year-old woman suffered from a severe bursting headache, vomiting, and a drowsy mentality. Brain computed tomography scan (A) revealed subarachnoid hemorrhage in the basal cistern and a small hematoma at the left Sylvian fissure. On cerebral catheter angiography (B), we identified a saccular aneurysm at the bifurcation of the left middle cerebral artery (black arrow). Postoperative chest X-ray (C) shows malpositioning of the central venous catheter in the internal jugular vein (white arrow).

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  Fig. 2 Contrast-enhanced brain CT scan (A) reveals venous infarction with hemorrhagic transformation in the right temporal lobe. Retrospective analysis of the CT scan showed an "empty delta sign" (black arrow), sufficient for diagnosis of sigmoid sinus thrombosis. On anteroposterior view of CT angiography (B), right internal jugular vein and sigmoid sinus are not found due to absence of venous outflow (white arrow heads). Eventually, the patient died due to severe pneumonia from septic emboli (C).

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