Lemierre's syndrome.Lemierre's syndrome is characterized by thrombophlebitis thrombophlebitis: see phlebitis. of the internal jugular vein internal jugular vein n. A vein that is a continuation of the sigmoid sinus of the dura mater and unites behind the cartilage of the first rib with the subclavian vein to form the brachiocephalic vein. and a spreading secondary infection. (1,2) When it occurs, it usually does so in young, previously healthy patients following an oropharyngeal infection accompanied by a persistently high fever. The overall incidence of this syndrome appears to be increasing. The primary pathogen in Lemierre's syndrome is Fusobacterium neerophorum, a gram-negative rod that normally inhabits the oropharynx. (1,2) Prolonged antibiotic treatment with good anaerobic anaerobic /an·aer·o·bic/ (an?ah-ro´bik) 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. coverage is vital to minimizing morbidity and mortality; the mortality rate associated with Lemierre's syndrome prior to the antibiotic era was nearly 90%. (3) Today, with early diagnosis and treatment, the mortality rate has decreased to 15%. (3) We evaluated a 21-year-old black man who presented with exudative exudative of or pertaining to a process of exudation. exudative diathesis a disease of young pigs and chickens caused by a nutritional deficiency of vitamin E. Characterized by severe edema of the subcutaneous tissues. tonsillitis and high fever. He had no significant medical history. Computed tomography (CT) of the neck detected a thrombosis of the right anterior jugular vein anterior jugular vein n. A vein that arises below the chin from the veins draining the chin and lower lip, passes down the front of the neck superficially, and terminates in the external jugular vein at the lateral border of the anterior scalene muscle. that extended from the level of the hyoid hyoid /hy·oid/ (hi´oid) shaped like Greek letter upsilon (?); pertaining to the hyoid bone. hy·oid adj. 1. Shaped like the letter U. 2. Of or relating to the hyoid bone. to the supraclavicular area (figure, A). CT of the chest revealed multiple cavitary pulmonary nodules throughout the pulmonary parenchyma (figure, B). Blood cultures were positive for F necrophorum, and the patient was treated with an appropriate antibiotic. A follow-up CT of the neck 4 weeks later showed a partial resolution of the thrombosis (figure, C). In the presence of appropriate clinical features, the clinician should consider Lemierre's syndrome when cross-sectional imaging of the neck and chest demonstrates a thrombosed thrombosed /throm·bosed/ (throm´bozd) affected with thrombosis. throm·bosed adj. 1. Clotted. 2. Of, being, or characterizing a blood vessel that is the seat of thrombosis. internal jugular vein and multiple septic emboli. References (1.) Gormus N, Durgut K, Ozergin U, et al. Lemierre's syndrome associated with septic pulmonary embolism: A case report. Ann Vasc Surg 2004; 18:243-5. (2.) Sagowski C, Koch U. [Lemierre syndrome: Thrombosis of the internal jugular vein after tonsillectomy]. HNO 2004;52:251-4. (3.) Weesner CL, Cisek JE. Lemierre syndrome: The forgotten disease. Ann Emerg Med 1993;22:256-8. David Kirsch, MD; Devin Tighe, MD; Michael G. D'Antonio, MD; Enrique Palacios, MD, FACR From the Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans. |
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