The wounds were closed on hospital day 14, but bleeding beneath the closure site forced removal of the sutures 4 days later. The wounds were allowed to close by secondary intention. Ultrasonography of the neck on hospital day 21 showed that the left internal jugular vein thrombus was still present but stable. Infection of the deep pharyngeal tissue allows anaerobic organisms to drain into the lateral pharyngeal space, which contains the internal jugular vein. This potential space is shaped like an inverted cone extending from the base of the skull to the thyroid bone and is bordered laterally and medially by fascia and muscle of the neck.
Anaerobic organisms cause septic thrombophlebitis of the internal jugular vein.
Often, there is swelling in the upper neck, with tenderness of the lateral aspect of the neck, parallel to the sternocleidomastoid muscle. Patients may complain of trismus or pain when turning the head away from the side of the thrombus. Three to 10 days after onset of sore throat, sepsis occurs, usually associated with high fevers, rigors, and elevated serum liver enzymes. Septic clots commonly dislodge from the internal jugular vein thrombus, resulting in infected pulmonary infarcts. Patients frequently have pleural effusions and occasionally have thoracic empyemas, with symptoms of dyspnea and pleuritic pain.