대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

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

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

This website is optimized for IE 10 and above.