Weekly Chest CasesCases by Disease Category

Case No : 1312 Date 2022-12-12

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  • Courtesy of Kyung Hee Lee / Bundang Seoul National University Hospital
  • Age/Sex 25 / F
  • Chief Complaintfever, neck pain (onset: 10 days ago)
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Lemierre syndrome
Radiologic Findings
Fig 1. Mutlifocal lung nodules in both lungs
Fig 2. Rt IJV thrombophelbitis
Fig 3. Multiple subpleural nodules, some with cavities, in both lungs.
Brief Review
Oropharyngeal infection (m/c) thrombophlebitis of the IJV systemic metastatic infection (lung, joint, brain..), anaerobic sepsis
Incidence decreased dramatically after introduction of antibiotics
Affects mainly healthy people (2nd, 3rd decades), M > F
Main organism: Fusobacterium necrophorum (gram-negative anerobe)

Imaging features
Chest x-ray
Numerous ill-defined rounded opacities, pleural effusion
CT
Primary infection focus (oropharyngeal infection, peritonsillar area)
Filling defect in the IJV
Multiple peripheral, round/wedge-shaped opacities that progress to cavitation (septic emboli), abscess
Please refer to
Case 657, Case 419,
KSTR imaging conference 2018 Spring  Case 17,
References
Ochsner Journal 2016;16:7
Keywords
Lemierre syndrome,

No. of Applicants : 113

▶ Correct Answer : 105/113,  92.9%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Ulsan University Hospital , Korea (South) SOYEOUN LIM
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Hospital of Sacred Heart, Montreal , Canada ANDREA OJANGUREN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) HWANGHEE JO
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Korea University Guro Hospital , Korea (South) YEJU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Korea University Ansan Hospital , Korea (South) HYO YOUNG KIM
  • - Osaka University , Japan AKINORI HATA
  • - , Japan HIKARI FUKUI
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Osaka Metropolitan University , Japan HIROTAKA TAKITA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yamanashi Prefectural Central Hospital , Japan HIROAKI WATANABE
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - , India JAHNAVI GADUPTI
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - Myongji Hospital , Korea (South) HYOUNG YEOB KIM
  • - , Japan KENTARO KOTANI
  • - Asan Medical Center , Korea (South) JIEUN KIM
  • - Pusan National University Yangsan Hospital , Korea (South) KUN HEE KIM
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - , Japan AOKI HIKARU
  • - tr , Turkey MEHMET KAYA
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - Asan Medical Center , Korea (South) BYUNGSOO IM
  • - Ulsan University Hospital , Korea (South) SUNGMIN KIM
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Mie University Hospital , Japan KENSUKE DOMAE
  • - , Japan MATSUNO MAI
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - , Japan NOBUYUKI OTANI
  • - , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chonnam National University Hospital , Korea (South) EUN JU KIM
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 4/113,  3.5%
  • - , China FANG YING GEN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Govt. Kilpauk Medical College, Chennai , India VIGNESH K
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