Head and Neck Imaging

Lemierre's syndrome

rare syndrome affecting otherwise healthy adolescents following a primary oropharyngeal infection. Characteristically, these patients develop:

  • trismus, tenderness and swelling along the angle of the mandible and sternocleidomastoid muscle with subsequent thrombophlebitis of the internal jugular vein;

  • bacteraemia with positive blood cultures for Fusobacterium necrophorum, a Gram-negative anaerobic organism normally inhabiting the oropharynx; and

  • evidence of distant septic infection, most commonly in the lungs, but also in the joints and liver; rarely the meninges may be involved.

    The radiological hallmarks of this syndrome are thrombosis of the internal jugular vein and metastatic infection (Fig.1). If not treated with antibiotics, the course of this syndrome is often fatal.

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    Fig.1

    Axial contrast-enhanced CT image of the neck shows left-sided internal jugular vein thrombosis (a, arrow). CT study performed on the same day shows an abscess in the right piriform muscle (b, arrow); chest CT showed the presence of nodular infiltrates, consistent with pulmonary emboli. (From: Gong J., Garcia J. Lemierre's syndrome. Eur Radiol 1999, 9: 672-674, with permission).
    Lemierre's syndrome, Fig.1 (a)
    Lemierre's syndrome, Fig.1 (b)