A case of suspected fungal mass in the right internal jugular vein detected by ultrasonography

Abstract

We report a suspected case of fungal mass in the right internal jugular vein. A 70-year-old man was admitted to our hospital with heart failure. He had a persistent fever and the inflammatory response increased. Serum β-D-glucan level was elevated, and Candida albicans was identified from blood culture. He was diagnosed with a fungal infection. A central venous catheter had been inserted into the right internal jugular vein for 3weeks. The ultrasonography showed a full mass image of 6 × 5mm which was attached to a string-like organizing thrombus of approximately 25mm long in the right internal jugular vein. The echogram presented a spherical and smooth outline, and slightly heterogeneous inside of the mass with scattered vesicular structures. We attempted to retrieve a foreign body using a catheter under ultrasound guidance. However, it cannot be detached from the vessel wall. Next, surgical resection was planned under intraoperative ultrasound examination, however, the surgical procedure was not performed because his general condition deteriorated. Fortunately, the level of β-D-glucan decreased after administration of amphotericin B and the foreign body, suspected fungal mass, became smaller on ultrasonography. We experienced a suspected patient with a fungal mass in the right internal jugular vein. Ultrasonography was useful in diagnosis, treatment or follow-up.