Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings

Abstract

Background: Thrombophlebitis of the internal jugular vein (IJV) secondary to neck infection (so-called Lemierre syndrome) is a rare disease.

Purpose: To evaluate the clinical and CT findings in patients with thrombophlebitis of the IJV.

Material and methods: The clinical and contrast-enhanced neck CT findings were retrospective analyzed in 10 patients (eight men, two women; mean age, 62.9 ± 8.3 years) with thrombophlebitis of the IJV.

Results: Five patients (50%) had complications, including pneumonia (n = 3), neck abscess (n = 1), and thrombophlebitis of cerebral venous sinus (n = 1). All patients, except two who were lost to follow-up, had improved after antibiotics and anticoagulation therapy. Nine (90%) patients had underlying infectious processes in the neck. Contrast-enhanced neck CT of 12 IJVs (five right, three left, and two bilateral) affected by thrombophlebitis demonstrated > 5 cm in length (n = 8, 67%), ovoid shape (n = 7, 58%), complete occlusion of the lumen (n = 10, 83%), circumferential (n = 11, 92%), smooth (n = 8, 67%), and thick (≥4 mm) (n = 8, 67%) rim enhancement, and adjacent soft tissue swelling (n = 11, 92%).

Conclusion: Contrast-enhanced CT is useful in the diagnosis of thrombophlebitis of the IJV; characteristic CT findings of this unusual entity may be the main clue to the correct diagnosis.

Keywords: Lemierre syndrome; Thrombophlebitis; computed tomography; internal jugular vein.