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Lemierre syndrome

Case contributed by Safwat Mohammad Almoghazy
Diagnosis certain

Presentation

Acute onset of server left arm, forearm, and neck swelling for 3 days and fever.

Patient Data

Age: 45 years
Gender: Female
ct
  • an intraluminal filling defect within the left internal jugular left brachiocephalic vein, the left subclavian and axillary veins with consequent multiple chest wall venous collateral are seen associated with anterior mediastinal fat congestion
  • mild fatty stranding is seen within the carotid sheath and the left side of the neck with inflammatory soft tissue phlegmon is seen involving the left supraclavicular region and multiple enlarged lymph nodes are seen
  • the retropharyngeal space shows a hypodense collection/edema
  • mild left pleural effusion with underlying subsegmental collapse

Case Discussion

A 45-year-old previously healthy female presented to the emergency department with the left arm and neck swelling and fever. 

The patient underwent to ultrasound of the neck (not provided) demonstrating left internal jugular vein thrombosis.

Contrast-enhanced CT of the neck and chest revealed thrombus along the left internal jugular vein consistent with septic thrombosis of the internal jugular vein and retropharyngeal hypodense collection/edema and mild left-sided mild pleural effusion.

Lemierre syndrome is a rare and potentially lethal entity. It consists of internal jugular venous thrombosis following a primary oropharyngeal infection with development of distant septic emboli, most often involving the lungs.

These are the classic imaging triad, as present in the case above.

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