Today’s images belong to a 38-year-old woman treated with antibiotics for a sore throat with fever. Six days later she goes to the ER with left chest pain and moderate dyspnea.
Findings: PA chest radiograph shows a pulmonary opacity at the left lung base (A, arrow), with obliteration of the costophrenic angle. The opacity is also visible in the lateral view (B, circle). Its appearance is non-specific, although the location favors a pulmonary infarct.
In this case, the main diagnostic help is the clinical information: chest pain and pulmonary infiltrates associated to a recent oropharyngeal infection suggest internal jugular thrombosis with associated sepsis and pulmonary emboli (Lemierre syndrome).
Axial CT shows left basal infiltrates suggestive of pulmonary infarcts (C, arrows). Doppler study and MR angio confirm thrombosis of the left jugular vein (D, red arrow). Blood culture was positive for Fusobacterium necrophorum.
Final diagnosis: Lemierre syndrome.
Congratulations to MK, who made an early diagnosis.
Teaching point: although Lemierre syndrome is supposed to be a rare clinical entity, the radiologist can suggest the diagnosis if she/he knows the clinical presentation, prompting early treatment.
