Lemierre's syndrome: septic internal jugular thrombophlebitis secondary to pharyngitis

Case contributed by Dr Mohammad A. ElBeialy


Acute swelling of the right arm with neck swelling and pain.

Patient Data

Age: 30 years
Gender: Male

Thrombosis of the right internal jugular vein evidenced by its distended caliber, enhancing wall and intraluminal low attenuation filling defects as well as thrombosis of the right brachiocephalic vein, the right subclavian and axillary veins with consequent multiple paravertebral collateral venous channels noted.

Overt peri-vascular relative hypoattenuating density with inflammatory soft tissue tumefaction is seen involving the right carotid space, posterior cervical space, right aspect of the visceral space and supra and infra retropharyngeal space with marginally enhancing hypodense collection. The lesion is noted compressing the right thyroid cartilage and trachea to the contralateral side, effacing the right parapharyngeal fat planes, it is extending anteriorly to encase the right lateral aspect of the anterior jugular vein and laterally being inseparable from the right sternocleidomastoid muscle.

Normal course and caliber of both carotid arteries as well as left jugular vessels. Normal superior vena cava. Bilateral multiple enlarged lymph nodes are seen at the submental and both submandibular and internal jugular chains groups bilaterally.

Case Discussion

Acute thrombosis of the right internal jugular and right brachiocephalic vein, right subclavian and axillary veins with inflammatory peri-vascular and neck spaces hypoattenuating lesion and collection as well as a small retropharyngeal marginally enhancing collection (likely an abscess / pseudo-abscess) as described consistent with septic thrombosis of the internal jugular vein (Lemierre's syndrome).

Lemierre's syndrome refers to the purulent or septic thrombophlebitis of the internal jugular vein as a complication of pharyngitis. Lemierre's disease could be even further complicated by distant metastatic abscesses in the lungs with septic pulmonary emboli, brain abscesses or elsewhere (septic arthritis can lead to acute osteomyelitis).     

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