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Weekly Chest CasesArchive of Old Cases

Case No : 1429 Date 2025-03-10

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  • 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.
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
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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