Demographics:
30 years old, Male
Indication:
Neck swelling, fever
Findings
- Irregular peripherally enhancing collection deep to the left sternocleidomastoid muscle with encasement of the left internal jugular vein, which is thrombosed from the skull base to the lower neck with associated wall enhancement
- Enlargement of the overlying SCM muscle with surrounding fat stranding and thickening of the platysma muscle
- Left sided laryngeal edema and retropharyngeal edema extending from C2-C5
- Reactive left greater than right cervical lymphadenopathy
- No pulmonary nodules or airspace disease in the visualized lung apices
Diagnosis
Septic thrombophlebitis of the left internal jugular vein (Lemierre syndrome)
Sample Report
Neck abscess deep to the sternocleidomastoid muscle measuring 3 x 2.5 x 3.5 cm with encasement of the left internal jugular vein and overlying cellulitis/myositis. Thrombosis and wall enhancement of the left IJ extending from the skull base to the lower neck are consistent with septic thrombophlebitis. These findings are concerning for Lemierre syndrome.
No nodules or airspace in the visualized lung apices; however consider chest CT to further evaluate for septic embolic disease.
Retropharyngeal edema without retropharyngeal abscess, which exerts mild mass effect on the pharyngeal airway.
Reactive cervical lymphadenopathy.
Discussion