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Weekly Chest CasesArchive of Old Cases

Case No : 1429 Date 2025-03-10

  • Courtesy of Sunjin Ryu, Junghoon Kim / Seoul National University Bundang Hospital
  • Age/Sex 25 / F
  • Chief ComplaintFever; History of recent upper respiratory infection
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Lemierre syndrome
Radiologic Findings
Figure 1. Chest posteroanterior (PA) radiograph demonstrates multifocal, peripheral, ill-defined, and nodular opacities in both lungs.
Figure 2. Axial chest computed tomography (CT) images reveal multiple subpleural ground-glass opacities (GGOs) and peripheral consolidations in both lungs. Some lesions exhibit the reverse halo sign and the feeding vessel sign.
Figure 3. Contrast-enhanced neck CT demonstrates right internal jugular vein thrombophlebitis, characterized by a non-opacified thrombus within the vein and surrounding soft tissue inflammation.
Brief Review
Lemierre syndrome is a rare but serious condition characterized by septic thrombophlebitis of the internal jugular vein (IJV), typically following an oropharyngeal infection such as tonsillopharyngitis or a peritonsillar abscess. It primarily affects young, healthy individuals in their 20s to 30s, with Fusobacterium necrophorum being the most common causative organism. The infection spreads to the IJV, forming a thrombus, and septic emboli disseminate through the bloodstream, most commonly affecting the lungs.
Neck CT with contrast often shows a non-opacified thrombus in the IJV with surrounding soft tissue inflammation. Chest X-rays may demonstrate rounded opacities, complementing the findings on CT. However, chest x-ray appears normal in 10% of patients. Chest CT typically reveals multiple subpleural nodules or wedge-shaped consolidations with GGOs, some displaying the reverse halo sign and feeding vessel sign, indicative of septic emboli and infarction.
References
1. Harper LK, Pflug K, Raggio B, April D, Milburn JM. Clinical Images: Lemierre Syndrome: The Forgotten Disease? Ochsner J. 2016 Spring;16(1):7-9.
2. Byrne, S.C., Hammer, M.M., Thomas, R. (2022). Imaging of Pulmonary Infections. In: Patlas, M.N., Katz, D.S., Scaglione, M. (eds) Atlas of Emergency Imaging from Head-to-Toe. Springer, Cham.
Keywords

No. of Applicants : 62

▶ Correct Answer : 57/62,  91.9%
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kyoto University , Japan SHO KOYASU
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Other , Korea (South) SEOL A LEE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - TB centre kasaragod. , India rikhy krishnan
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - , Korea (South) DONG-HO BANG
  • - , China FANG YING GEN
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Other , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) JUN GU KANG
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Korea (South) HEONSEOK LEE
  • - , Albania AN G
  • - , Japan JUN YOSHIDA
  • - Osaka University , Japan AKINORI HATA
  • - Chonnam National University Hospital , Korea (South) JAEBONG YANG
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Presbyterian Medical Center , Korea (South) HANLIM SONG
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Oita university , Japan AYUMI KAMEI
  • - radiology , France DAVID BENKHALIFA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - , Japan SUZUNE TSUKAMOTO
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - , Japan YUMI MAEHARA
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan SHUHEI NORIMOTO
  • - , Japan YOSHIKI ISHII
  • - Other , Korea (South) CHAEHUN LIM
  • - Mie university , Japan SHIKO OKABE
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