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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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2
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Dai YL, Chen VM, Hedges TR, Malek A. Lemierre syndrome associated mycotic cavernous sinus thrombosis and carotid aneurysm after COVID-19. Am J Ophthalmol Case Rep 2022; 27:101642. [PMID: 35782172 PMCID: PMC9238024 DOI: 10.1016/j.ajoc.2022.101642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this article is to report a case of Lemierre syndrome associated mycotic aneurysm of the intracavernous carotid artery leading to cavernous sinus syndrome in an otherwise healthy, young man in the setting of COVID-19 infection. Observations An 18-year-old, otherwise healthy male athlete developed fever, chills, and headache and was found to be positive for COVID-19 with gram negative bacteremia. While on systemic antibiotic treatment, he developed acute, left-sided, 6th nerve palsy and was found to have bacterial sinusitis, left-sided intracavernous mycotic aneurysm, and cavernous sinus thrombosis on imaging studies. Despite systemic antibiotic and antiplatelet therapy, he developed progressively worsening left-sided ophthalmoplegia and vision decline. He subsequently underwent left internal carotid artery embolization and cervical internal carotid artery sacrifice with excellent outcome. Conclusion and importance Lemierre syndrome can have atypical presentations and complications, including cavernous sinus thrombosis and mycotic aneurysms. Recognition of signs and symptoms, including progressive multiple cranial neuropathies, can aid in early diagnosis and management, which requires multidisciplinary care tailored to each individual based on risk of intervention.
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Affiliation(s)
- Yi Ling Dai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Corresponding author. New England Eye Center/Tufts Medical Center, Department of Ophthalmology, 800 Washington Street, Boston, MA, 02116, USA.
| | - Vicki M. Chen
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
| | - Thomas R. Hedges
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Department of Neurology, Tufts Medical Center, Boston, USA
| | - Adel Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, USA
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Bordet M, Long A, Tresson P. Mycotic Pseudoaneurysm of Carotid Artery as a Rare Complication of Lemierre Syndrome. Mayo Clin Proc 2021; 96:3178-3179. [PMID: 34863401 DOI: 10.1016/j.mayocp.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Marine Bordet
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Anne Long
- Department of Internal Medicine and Vascular Medicine, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Philippe Tresson
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Colbert C, McCormack M, Eilbert W, Bull L. Lemierre Syndrome as a Complication of Laryngeal Carcinoma. Clin Pract Cases Emerg Med 2018; 2:78-81. [PMID: 29849275 PMCID: PMC5965148 DOI: 10.5811/cpcem.2017.12.36442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/07/2017] [Indexed: 11/11/2022] Open
Abstract
Lemierre syndrome is a rare condition characterized by a septic thrombophlebitis of the internal jugular vein with septicemia and metastatic foci of infection. It typically occurs as the result of an infection in the head and neck, most commonly pharyngitis. For reasons that are unclear, the incidence of Lemierre syndrome has been increasing over the past 15 years. Diagnosis of Lemierre syndrome is often delayed, and identification of internal jugular vein thrombosis is often the first indicator of its presence. We report a case of Lemierre syndrome associated with a laryngeal carcinoma.
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Affiliation(s)
- Christopher Colbert
- University of Illinois at Chicago, College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Molly McCormack
- University of Illinois at Chicago, College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Wesley Eilbert
- University of Illinois at Chicago, College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Lynea Bull
- St. Louis University School of Medicine, St. Louis, Missouri
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Abstract
We report a 21-year-old young male with Lemierre's syndrome presented as tonsillitis and Fusobacterium septicemia with respiratory failure and required intensive care. Lemierre's syndrome is the septic embolic complication of recent pharyngeal illness. Fusobacterium spp. accounts for the majority of cases. High index of suspicion is needed and prolonged antibiotic is advised. It is seldom seen in intensive care but should never be forgotten.
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Affiliation(s)
- Man-Yee Man
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Hoi-Ping Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Wing-Wa Yan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong SAR, China
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Benedetto F, Barillà D, Pipitò N, Derone G, Cutrupi A, Barillà C. Mycotic Pseudoaneurysm of Internal Carotid Artery Secondary to Lemierre's Syndrome, How to Do It. Ann Vasc Surg 2017; 44:423.e13-423.e17. [DOI: 10.1016/j.avsg.2017.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 11/28/2022]
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Zhao A, Samannodi M, Tahir M, Bensman S, Hocko M. Lemierre's syndrome: Case report and brief literature review. IDCases 2017; 10:15-17. [PMID: 28808620 PMCID: PMC5552024 DOI: 10.1016/j.idcr.2017.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 01/26/2023] Open
Abstract
Lemierre’s syndrome has been shown to be increasing in incidence in the past 20 years with one popular suggesting that said rise occurred from less aggressive antibacterial coverage. We report a case of Lemierre’s syndrome and also reviewed the 15 most recent case reports. A previously healthy 25 year old male who initially developed sore throat and flu-like symptoms, was prescribed antibacterials as an outpatient but was hospitalized for worsening symptoms. He was later diagnosed with Lemierre’s syndrome and improved clinically with IV antimicrobials alone. From our concise literature review, we determined that a decrease in antibiotic prescriptions may not fully explain why the incidence of Lemierre’s has been increasing. Thus, future research should be focused in evaluating possible worsening susceptibilities to antibiotics and improvements on detection. We also advise physicians to be aware of the signs and symptoms of this rare but potentially fatal condition as well as the available detection methods and treatment
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Affiliation(s)
- Andrew Zhao
- Mayo Clinic Health System - Franciscan Healthcare, 815 10th Street, South La Crosse, WI, 54601, United States
| | | | - Muhammad Tahir
- Department of medicine, Catholic Health System, University at Buffalo
| | - Sarah Bensman
- Department of medicine, Catholic Health System, University at Buffalo
| | - Michael Hocko
- Department of medicine, Catholic Health System, University at Buffalo
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Alperstein A, Fertig RM, Feldman M, Watford D, Nystrom S, Delva G, Muddassir S. Septic thrombophlebitis of the internal jugular vein, a case of Lemierre's syndrome. Intractable Rare Dis Res 2017; 6:137-140. [PMID: 28580216 PMCID: PMC5451747 DOI: 10.5582/irdr.2017.01021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 18-year-old gentleman with a history of recurrent tonsillitis presented to the emergency room complaining of worsening sore throat. He was found to have a peritonisillar abscess, and imaging revealed a non-occlusive left internal jugular vein thrombosis. Lemierre's syndrome is a rare, potentially fatal condition characterized by internal jugular vein thrombosis with septicemia following an acute oropharyngeal infection. While anticoagulation is the mainstay of treatment of deep venous thromboembolism (DVT) and pulmonary embolism (PE), the use of therapy is controversial in septic thrombophlebitis. This is counterintuitive since a common reported complication is pulmonary emboli. Early in the course of thrombophlebitis, while the thrombus is firmly attached, antibiotics may be all that is necessary to treat the condition.
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Affiliation(s)
- Adam Alperstein
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Raymond M. Fertig
- University of Miami, Miller School of Medicine, Miami, FL, USA
- Address correspondence to: Dr. Raymond Fertig, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1475 NW 12th Ave, 2nd Floor Miami Florida, 33136, USA. E-mail:
| | - Matthew Feldman
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Daniel Watford
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan Nystrom
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Guesly Delva
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Salman Muddassir
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
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