Dr. Duneant, PGY-2 EM resident at HUM, found this clot in the right IJ of a patient in the ICU. The patient had signs and symptoms highly suggestive of a pulmonary embolism however sonographic DVT studies were negative bilaterally. The probe was placed over the right IJ in anticipation of placement of a central line.
Here is the normal left IJ for comparison:
And another investigation of the right IJ:
The patient was appropriately started an anticoagulation. Great find! And another reminder of how helpful ultrasound is in diagnosing disease and guiding procedures. Good thing the procedure wasn’t performed blind!