Investigations for septic jugular thrombophlebitis
To assist with diagnosis and assessment of potential complications in patients with suspected septic jugular thrombophlebitis, the following initial investigations should be considered, but should not delay administration of antibiotics:
- blood culture
- in adults, collect 3 sets of blood samples for culture before starting antibiotic therapy.
- in children, collect a minimum of 2 sets of blood samples for culture, including a dedicated anaerobic sample. A third sample is recommended in children, if practical
- throat or oropharyngeal abscess swab – for patients with clinically apparent odontogenic or tonsillar disease, perform a throat or abscess swab
- neck ultrasound – to confirm or exclude the presence of jugular venous thrombosis, perform a dedicated doppler ultrasound of the major neck vessels
- chest X-ray – to assess for evidence of large pulmonary septic emboli in patients with confirmed septic jugular thrombophlebitis, perform a chest X-ray
- computed tomography (CT) or magnetic resonance imaging (MRI) of the neck – to further assess infraclavicular extension if there is clinical concern, perform a CT or MRI of the neckAuber, 2000
- echocardiography – if endocarditis is considered a differential diagnosis (ie patients with non-odontogenic flora or Staphylococcus aureus), perform a transthoracic echocardiogram (TTE) as an initial assessment.