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Lemierre syndrome

Is defined as suppurative thrombophlebitis of internal jugular vein.

Etiology:

This syndrome is caused by extension of infection into the carotid space.  source of infection could be any of the deep neck space infections.

Clinical features:

1. Swelling and redness over the angle of the jaw and along the sternocleidomastoid muscle
2. Spiking fevers
3. Chills
4. Evidence of pulmonary embolism.

Investigations:

High index of suspicion is necessary.

1. High resolution ultrasonography
2. CECT scan (contrast enhanced computerized tomography)
3. MRI / MRA

Treatment:

Prolonged course of antimicrobial therapy.  The choice of drug is dependent on culture / sensitivity results.

Anticoagulants are recommended for 3 months when there is evidence of thrombus progression / evidence of septic emboli.

Fibrinolytics can be prescribed if this syndrome is recognized within 4  days of onset.

Surgical ligation / resection of internal jugular vein is reserved for patients with evidence of septic pulmonary emboli not resolving to medical management.

Endovascular stenting / superior vena cava filters can also be considered.

Dangers of Lemierre syndrome:

Carotid aneurysm

Septic pulmonary emboli
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