Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings

Abstract

Background Thrombophlebitis of the internal jugular vein (IJV) secondary to neck infection (so-called Lemierre syndrome) is a rare disease. Purpose To evaluate the clinical and CT findings in patients with thrombophlebitis of the IJV. Material and Methods The clinical and contrast-enhanced neck CT findings were retrospective analyzed in 10 patients (eight men, two women; mean age, 62.9 ± 8.3 years) with thrombophlebitis of the IJV. Results Five patients (50%) had complications, including pneumonia ( n = 3), neck abscess ( n = 1), and thrombophlebitis of cerebral venous sinus ( n = 1). All patients, except two who were lost to follow-up, had improved after antibiotics and anticoagulation therapy. Nine (90%) patients had underlying infectious processes in the neck. Contrast-enhanced neck CT of 12 IJVs (five right, three left, and two bilateral) affected by thrombophlebitis demonstrated > 5 cm in length ( n = 8, 67%), ovoid shape ( n = 7, 58%), complete occlusion of the lumen ( n = 10, 83%), circumferential ( n = 11, 92%), smooth ( n = 8, 67%), and thick (≥4 mm) ( n = 8, 67%) rim enhancement, and adjacent soft tissue swelling ( n = 11, 92%). Conclusion Contrast-enhanced CT is useful in the diagnosis of thrombophlebitis of the IJV; characteristic CT findings of this unusual entity may be the main clue to the correct diagnosis.