Isolated Internal jugular vein thrombosis as the first presentation of gastric adenocarcinoma

Internal jugular vein (IJV) thrombosis is a very rare vascular disease that is usually the result of trauma, infectious disease, and central vein thrombosis. Malignancy, either known or occult, is an uncommon etiology of IJV thrombosis.The presented patient was a 49-year-old woman who suffered from painful swelling in the right side of her neck. Physical examination revealed a painful and immobile mass in the right side of her neck. Doppler ultrasonography scan showed thrombosis of the right IJV.  Initial workups to find malignancy were unremarkable. She underwent treatment by intravenous heparin and antibiotics and her symptoms resolved after one week. Six months later, the patient presented once more with repeated vomiting and epigastric pain. On gastroesophageal endoscopy, a mass in the lesser curve of the stomach was detected. The pathology report was compatible with gastric adenocarcinoma.Association between IJV thrombosis and some malignancies (e.g., lung and lymphoma) have been reported. IJV thrombosis can be the first presentation of malignancy. IJV thrombosis should be kept in mind in patients with painful swelling in the neck and long- term follow-up to exclude any malignant diseases is recommended