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Schwarz Y, Habashi N, Rosenfeld-Yehoshua N, Soikher E, Marom T, Tamir SO. Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review. Int Arch Otorhinolaryngol 2021; 25:e633-e640. [PMID: 34737835 PMCID: PMC8558952 DOI: 10.1055/s-0040-1721337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Lemierre syndrome (LS) involving the external jugular vein (EJV) is rare, and only a few cases have been reported in the literature. Objectives To report a case of LS involving the external jugular vein as well as to make a review of the literature regarding both diagnosis and management strategies. Data Synthesis We describe a case of LS involving the EJV and review the literature of previously published articles to search for additional cases. A PubMed, Embase, Scopus, and Web of science-based search was performed to determine the scope of coverage in well-reported articles in English. Twenty-one papers were retrieved and documented for age, incidence, pathogen, presenting symptoms, imaging, treatment, and outcome, which were noted for each of these cases. In our literature review of 21 papers, there were 16 patients (61%) in their 2nd and 3rd decades of life. Lemierre syndrome was shown to affect females and males equally. The presenting symptoms were a sore throat and fever. Treatment requires intravenous antibiotics, and there is no consensus regarding treatment with anticoagulation. Conclusions The present case report and review of the literature emphasize the importance of history taking as well as physical examination in what seems to be a case of simple tonsillitis.
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Affiliation(s)
- Yehuda Schwarz
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Nadeem Habashi
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Noa Rosenfeld-Yehoshua
- Department of Pediatric Intensive Care Unit, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Eugene Soikher
- Department of Radiology, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
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Reicher J, Brooke S, Arnold D, Counter P, Abdelgalil A. An unusual case of cavitating pulmonary nodules: Lemierre’s syndrome with isolated involvement of the external jugular vein. BJR Case Rep 2018; 4:20170093. [PMID: 31489210 PMCID: PMC6711281 DOI: 10.1259/bjrcr.20170093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/27/2017] [Accepted: 02/04/2018] [Indexed: 11/23/2022] Open
Abstract
A 65-year-old female presented with symptoms of tonsillitis and sepsis. Despite
initial treatment with i.v. fluid and antibiotics, her condition deteriorated
and she became hypoxaemic. CT pulmonary angiography showed no filling defects in
the pulmonary arteries, but there were multiple cavitating lung nodules,
initially thought to represent metastases. A subsequent contrast-enhanced CT of
the neck and thorax demonstrated thrombosis of the left external jugular vein
(EJV), leading to a revised diagnosis of Lemierre’s syndrome
(i.e. septic embolization from jugular thrombophlebitis).
Noteworthy aspects of the case include the initial misdiagnosis of the
cavitating lung nodules by the reporting radiologist and the isolated
involvement of the EJV—Lemierre’s syndrome usually involves the
internal jugular vein. The case highlights the importance of septic emboli in
the differential diagnosis of cavitating lung nodules, and of assessment of the
EJV as well as internal jugular vein in the context of oropharyngeal
infection.
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Affiliation(s)
- John Reicher
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Sam Brooke
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Dominic Arnold
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Paul Counter
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
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Hatakeyama H, Fujima N, Tsuchiya K, Mizoguchi K, Mizumachi T, Sakashita T, Kano S, Homma A, Fukuda S. Osteoradionecrosis of the hyoid bone after intra-arterial chemoradiotherapy for oropharyngeal cancer: MR imaging findings. Cancer Imaging 2017; 17:22. [PMID: 28750685 PMCID: PMC5531026 DOI: 10.1186/s40644-017-0123-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background Osteoradionecrosis (ORN) of the hyoid bone sometimes induces severe front neck infection and can cause laryngeal stenosis and carotid rupture. Although ORN of the hyoid bone is known to be a complication of chemoradiotherapy for head and neck cancer, there has been no basis for its evaluation. Our purpose is to present the clinical and MR imaging features of ORN of the hyoid bone. Methods The study group comprised patients with advanced oropharyngeal cancer treated with targeted intra-arterial cisplatin infusion with concomitant radiotherapy. ORN of the hyoid bone was identified on the basis of decreased signal intensity of the bone marrow on T1WI images. Signal intensity on T2WI images was used to distinguish between inflammation and fibrosis. Results A total of 39 pre-treatment MR images and follow-up MR images were reviewed. ORN of the hyoid bone were detected in 30% of patients after treatment, with 23% of them showing inflammation and 7.7% fibrosis. Two patients developed severe neck infection and received antibiotics and underwent surgical intervention by tracheostomy and resection of the hyoid bone. Conclusion Our MR imaging study showed that ORN of the hyoid bone is not particularly rare in patients with oropharyngeal cancer treated with chemoradiotherapy. Clinicians should evaluate images carefully to prevent the development of severe complication due to infection associated with ORN of the hyoid bone.
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Affiliation(s)
- Hiromitsu Hatakeyama
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan. .,Department of Otolaryngology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Noriyuki Fujima
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Tsuchiya
- Department of Radiotherapy, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenji Mizoguchi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Abstract
BACKGROUND Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow's triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood resides there and flows against gravity. The veins of the lower extremities are dependent on intact valves and fully functional leg muscles. However, in case of valvular incompetency or muscular weakness, thrombosis and blood stasis will occur as a result. In contrast, the veins of the neck, specially the jugulars, have distensible walls which allow flexibility during respiration. In addition, the blood directly flows downward towards the heart. Nevertheless, many case reports mentioned the thrombosis of internal jugular veins and external jugular veins with identified risk factors. Jugular vein thrombosis has previously been associated in the literature with a variety of medical conditions, including malignancy. CASE REPORT This report is of a case of idiopathic bilateral external jugular vein thrombosis in a 21 year-old male construction worker of Southeast Asian origin with no previous medical history who presented with bilateral facial puffiness of gradual onset over 1 month. Doppler ultrasound and computed tomography were used in the diagnosis. Further work-up showed no evidence of infection or neoplasia. The patient was eventually discharged on warfarin. The patient was assessed after 6 months and his symptoms had resolved completely. CONCLUSIONS Bilateral idiopathic external jugular veins thrombosis is extremely rare and can be an indicator of early malignancy or hidden infection. While previous reports in the literature have associated jugular vein thrombosis with malignancy, the present case shows that external jugular vein thrombosis can also be found in persons without malignancy.
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Affiliation(s)
- Zakaria Hindi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ehab Fadhel
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Hagiya H, Haruki Y, Otsuka F. Lemierre syndrome involving external jugular vein. Acute Med Surg 2014; 2:64-68. [PMID: 29123694 DOI: 10.1002/ams2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/20/2014] [Indexed: 11/06/2022] Open
Abstract
Case A 74-year-old woman with a week-long history of cold symptoms was diagnosed with Lemierre syndrome that involved her left external jugular vein. Outcome The patient was successfully treated with 4 weeks of antibiotics and anticoagulant treatment. Typical cases of Lemierre syndrome involve only the internal jugular vein. The external jugular vein is anatomically distant from the pharyngolaryngeal space and usually does not receive blood or lymphatic flow from there. Thus, Lemierre syndrome ordinarily does not involve the external jugular vein and clinical characteristics of external jugular vein-involving Lemierre syndrome have not been uncovered, mainly due to its rarity. Based on our review, it would not much differ from those of typical cases. Conclusion Considering the potential severity and mortality, more attention should be paid to this potentially fatal disease that may demonstrate atypical manifestation, as shown in this case. Accumulation of cases would be needed for further understanding.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tsuyama Okayama Japan
| | - Yuto Haruki
- Department of Pharmacy Tsuyama Central Hospital Tsuyama Okayama Japan
| | - Fumio Otsuka
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tsuyama Okayama Japan
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Sanz Hernández M, de Grado Manchado T, González P, Ruiz-Yagüe M. Trombosis de la vena yugular externa. Rev Clin Esp 2009; 209:55-6. [DOI: 10.1016/s0014-2565(09)70362-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C. A Lemierre syndrome variant caused by Staphylococcus aureus. Am J Emerg Med 2008; 26:380.e5-7. [DOI: 10.1016/j.ajem.2007.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 05/16/2007] [Indexed: 10/22/2022] Open
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Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev 2007; 20:622-59. [PMID: 17934077 PMCID: PMC2176048 DOI: 10.1128/cmr.00011-07] [Citation(s) in RCA: 360] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human infection with Fusobacterium necrophorum usually involves F. necrophorum subsp. funduliforme rather than F. necrophorum subsp. necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests that F. necrophorum can be limited to the throat and cause persistent or recurrent tonsillitis. F. necrophorum is unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.
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Affiliation(s)
- Terry Riordan
- Microbiology Department, Royal Devon & Exeter Foundation Trust, Exeter, United Kingdom.
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Sano D. Poster 027: A Case of Deep Neck Abscess by Which Ring Enhancement of the External Jugular Vein Became an Indicator of the Diagnosis. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Westhout F, Hasso A, Jalili M, Afghani B, Armstrong W, Nwagwu C, Ackerman LL. Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report. J Neurosurg 2007; 106:53-6. [PMID: 17233314 DOI: 10.3171/ped.2007.106.1.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.
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Affiliation(s)
- Franklin Westhout
- Department of Neurosurgery, School of Medicine, University of California, Irvine, USA.
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11
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Moore BA, Dekle C, Werkhaven J. Bilateral Lemierre's Syndrome: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208100412] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.
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Affiliation(s)
- Brian A. Moore
- Department of Otolaryngology-Head and Neck Surgery, the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tenn
| | - Catherine Dekle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jay Werkhaven
- Department of Otolaryngology-Head and Neck Surgery, the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tenn
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Sengupta S, Kalkonde Y, Khot R, Paithankar M, Salkar R, Salkar H. Idiopathic bilateral external jugular vein thrombosis--a case report. Angiology 2001; 52:69-71. [PMID: 11205934 DOI: 10.1177/000331970105200110] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors report a patient with the rare presentation of bilateral external jugular vein thrombosis. A 45-year-old man presented with swelling over both sides of the neck and puffiness of the face. Physical examination revealed cordlike thickening of both the external jugular veins. Two-dimensional echocardiographic and Doppler studies showed thrombosis of both the external jugular veins and digital subtraction angiography (DSA) revealed nonvisualization of external jugular veins of either side. No malignancy, coagulation disorder, or any infection was demonstrable. A regular follow-up for 1 year was done, but no other cause could be found and there was no progression of the disease.
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Affiliation(s)
- S Sengupta
- Department of Medicine, Government Medical College, Nagpur, India.
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