[Diagnostic imaging in Lemierre's+ syndrome]

Abstract

Background: The Lemierre syndrome is a septic picture with jugular thrombophlebitis and secondary septic embolisms usually produced by Fusobacterium necrophorum. In previous reports published in the literature, imaging techniques are seldom referred to report the presence of jugular thrombophlebitis. A case of the Lemierre syndrome is presented with the aim of calling attention to this process and its current diagnostic possibilities.

Methods: The case of a patient who was diagnosed of having a Lemierre syndrome with sepsis by Fusobacterium is presented, with radiologic pulmonary embolisms. The echo-Doppler exam showed the presence of internal jugular involvement in absence of signs and symptoms leading to suspicion. A review of 6 cases is also made with special attention being given to the data on jugular vein involvement.

Results: Only in 2 of the 6 patients reviewed were imaging techniques used on the internal jugular view (in one 2D echography and in the other computerized axial tomography) with the diagnosis being performed on the base of symptomatic and physical exam data in the remaining 4 cases.

Conclusions: The Lemierre syndrome should be suspect in all patients with bacteremia by Fusobacterium and radiologic imaging of pulmonary embolism, even in the absence of signs and symptoms of oropharyngeal and jugular involvement. Modern imaging techniques, particularly echo-Doppler, may play an important diagnostic role.