Lemierre's syndrome diagnosed using bedside ultrasound in the emergency department

Abstract

Background

Lemierre's syndrome (LS) is a rare disease, typically occurring after a recent oropharyngeal infection. It is characterized by septic thrombophlebitis of the internal jugular (IJ) vein and bacteremia with metastatic septic emboli. Computed tomography (CT) of the neck with intravenous contrast is the imaging study of choice to diagnose the IJ vein thrombosis present with LS.

Case report

We present the case of an 18-year-old male who presented to the emergency department (ED) with right sided neck pain and shortness of breath. He had been seen in the ED two days earlier complaining of sore throat and was diagnosed with a viral infection. CT examinations of the neck and chest with intravenous contrast found multifocal bilateral nodular pulmonary densities with some soft tissue stranding adjacent to the right carotid sheath. No intraluminal filling defects of the right IJ vein were noted. A bedside ultrasound revealed a non-compressible hyperechoic thrombus in the right IJ vein, confirming the diagnosis of LS. To our knowledge, this is only the second reported case of LS diagnosed using bedside ultrasound that was initially missed on CT.

Why should an emergency physician be aware of this? Rapid recognition of LS, a potentially fatal illness, is paramount to optimize outcome. Bedside ultrasound is a useful tool available to emergency physicians to diagnose this disease and initiate prompt treatment.