0:01

This was a somewhat complicated case.

0:03

The patient had an anterior cervical discectomy at

0:06

C7-T1 and then had a CSF leak at the

0:15

junction of the jugular vein to the subclavian vein

0:19

on the left side where the thoracic duct entered and

0:25

had exploration for repair of that CSF leak.

0:30

Shortly thereafter,

0:32

the patient presented with left-sided neck pain.

0:34

So we're going to look at the carotid

0:36

sheath on the left side,

0:39

and we're starting at the skull base,

0:40

and almost immediately you can see that there is

0:43

pathology here in that we have the internal

0:46

carotid artery right and left.

0:49

On the left side, we're seeing the jugular vein,

0:52

but on the right side we have this low-density

0:55

tissue which is in the post-thyroid parapharyngeal

1:00

space. Again, this is the styloid process.

1:02

So behind it, here's the internal carotid artery.

1:05

As we go down, we see the inflammatory process.

1:09

In the left carotid sheath,

1:12

we still don't see the jugular vein.

1:14

On the left side,

1:16

we see a little peripheral rim of hyperdensity,

1:19

which likely represents the lumen of the thrombosed

1:22

jugular vein as we continue further inferiorly.

1:26

Again, we have a little hyperdense halo

1:30

of the jugular vein. In fact,

1:32

it kind of looks like an enlarged jugular

1:33

vein compared to the contralateral side.

1:37

And here we have it nice and round

1:40

with the thrombus within it.

1:43

The wall enhancement signifying thrombophlebitis.

1:47

The adjacent soft tissue in the carotid sheath

1:51

displacing the internal and external carotid artery

1:54

medially from the carotid sheath pathology.

1:57

And we can continue down inferiorly.

2:01

We actually see a branch of the jugular

2:03

vein which is also thrombosed.

2:07

And we can follow this all the way

2:09

down into the chest region.

2:12

Here is the postoperative air from the exploration

2:15

for the CSF leak, but as you can see,

2:19

it has led to the jugular vein thrombosis.

2:23

Here you can see that there is circumferential

2:25

tissue around the left common carotid artery,

2:29

identified arteritis inflammation around the carotid

2:33

artery within the carotid sheath as well.

2:37

So this is a postoperative complication of internal

2:41

jugular vein thrombosis associated with

2:45

thrombophlebitis and leading to carotid artery

2:49

arteritis within the right carotid sheath.