2001 Volume 94 Issue 11 Pages 1033-1037
We report a case of Lemierre's syndrome, known as postanginal sepsis, which resulted in internal jugular vein thrombosis with septic pulmonary embolism.
A 53-year-old man was admitted with sore throat, fever, and left-sided neck pain and swelling. He had no chest pain and no dyspnea. Contrast enhanced CT scan of the neck revealed swelling of the left tonsil without abscess formation and low-density lumen with peripheral enhancement of the wall of the left internal jugular vein. Chest CT scan showed multiple round nodules with cavitation indicating the typical appearance of septic pulmonary embolism. There was no definite pleural effusion. Streptococcus intermedius was found on blood cultures. Based on the findings we diagnosed left internal jugular vein thrombosis with septic pulmonary embolism due to acute tonsillitis, and administration of intravenous antibiotics and heparin was started. Fever subsided by hospital day 7, and the neck swelling and tenderness gradually reduced. Three months later, pulmonary nodules disappeared; however no blood flow of the internal jugular vein was noted, suggesting organization of the thrombus in the vein.
The treatment of internal jugular vein thrombosis is also discussed.
