Surgical intervention of Lemierre's syndrome: a case report and review of the literature.

BACKGROUND: Lemierre's syndrome is a fatal and rare disease that is typically characterized by oropharyngeal infection and internal jugular vein thrombosis. Timely institution of appropriate antibiotics is the standard treatment. CASE PRESENTATION: The authors report a case of Lemierre's syndrome. A 67-year-old male patient of Han ethnicity in China suffered from a large inflammatory neck mass involving left internal jugular vein thrombosis diagnosed as Lemierre's syndrome and finally cured by surgical treatment. In addition, a literature review was carried out through PubMed using the terms "Lemierre's syndrome/disease and review, meta-analysis or retrospective study" and "Lemierre's syndrome/disease and internal jugular vein". This search yielded six articles that recorded surgical methods such as drainage, craniotomy, tooth extraction, and ligation of the occluded vein to give clinicians more ideas about the treatment of the Lemierre's syndrome. CONCLUSION: This is the first review to summarize the conditions under which surgical treatment are conducted. Additionally, this is the first report of such a large inflammatory neck mass that was completely cured by surgical resection and internal jugular vein ligation. The authors also offer several conclusions regarding surgical intervention in Lemierre's syndrome for the first time.

Treatment of Catheter-Associated Internal Jugular Vein Thrombosis Using Apixaban for Less Than Three Months in Two Patients With Aggressive B-cell Lymphoma Undergoing Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone Therapy.

The selection of anticoagulant therapy and appropriate duration of treatment for central venous (CV) catheter-associated internal jugular vein thrombosis in patients with malignant lymphoma remain unclear. Two cases of aggressive B-cell lymphomas treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), in which apixaban administered for less than three months was effective against CV catheter-associated internal jugular vein thrombosis, are reported. In one case, the right internal jugular vein thrombosis developed after eight courses of R-CHOP; when apixaban was orally administered for 37 days after the CV catheter was removed, the thrombus completely dissolved and did not recur for 27 months. In the other case, right internal jugular vein thrombosis developed after four courses of R-CHOP; two additional courses of the R-CHOP were administered alongside oral apixaban administration without catheter removal. After 66 days of oral apixaban, the thrombus completely dissolved, the CV catheter was removed, and no recurrence was observed for 8.5 months.

Comparison of supraclavicular brachiocephalic and femoral vein approaches for tunneled dialysis catheter placement in patients with thrombosed internal jugular veins.

INTRODUCTION: There is still debate on the best access route in case of bilateral internal jugular vein thrombosis. We aimed to compare the safety, effectiveness, and outcomes of tunneled dialysis catheter placement via supraclavicular brachiocephalic and femoral vein approaches in patients with bilateral internal jugular vein thrombosis. METHODS: Between January 2018 and December 2021, data of the patients in whom tunneled dialysis catheters were placed via the supraclavicular brachiocephalic vein (n = 42) and femoral vein (n = 57) approaches were extracted. Patient demographics, technical and clinical success rates, complications, and outcomes were noted. The Likert scale was used to assess patient satisfaction. FINDINGS: Forty two (42.4%) patients were men, and the mean age was 61.9 (range, 12-93) years. The technical and clinical success rate was 100% for both groups. No major complication was encountered. The mean follow-up period was 497.5 (range, 32-1698) catheter days. Thirty-day patency was similar for the brachiocephalic vein and femoral vein group (40 [95.2%] vs. 55 [96.5%], p = 0.754). Also, primary and cumulative patency rates were comparable (p = 0.158; p = 0.660). The infection rate was 2.6 and 4.1 per 1000 catheter days for the brachiocephalic vein and femoral vein group. The infection-free survival was significantly higher in the brachiocephalic vein group (71.9% vs. 35.3% at 12 months, p < 0.001). Patient satisfaction was higher in the brachiocephalic vein group (median satisfaction, 5 vs. 4, p < 0.001). DISCUSSION: Both supraclavicular brachiocephalic vein and femoral vein approaches have high technical and clinical success with comparable patency rates. However, low infection rate and high patient satisfaction make the supraclavicular brachiocephalic vein approach a reasonable alternative before proceeding to the femoral vein access.

Lemierre Syndrome: Incidental Finding of Forgotten Fatal Disease as a Complication of Ludwig's Angina.

Lemierre syndrome (LS) is a rare, life-threatening complication of oropharyngeal infections associated with septicemia and internal jugular thrombosis. Internal jugular vein thrombosis is an uncommon disease associated with central vein catheterization, intravenous drug abuse, hypercoagulability, trauma to the neck, infection, ovarian hyperstimulation syndrome (OHSS), and systemic infections. Here, we highlight a case of a 62-year-old women who presented progressively worsening neck swelling for three weeks, shortness of breath, and fever for four days. Her sepsis due to Ludwig's angina was accompanied by septic pulmonary embolism and internal jugular vein thrombosis in keeping with a diagnosis of Lemierre syndrome. For this presentation of Lemierre syndrome, the treating physicians recommended surgical excision and drainage, followed by intravenous antibiotics and subcutaneous anticoagulation to treat septic emboli of the lungs and internal jugular veins. Sadly, after being informed about the procedure, the patient refused to consent, and four days later, she passed away. It is essential to remember that early detection and aggressive treatment may significantly impact prognosis and outcome.

Concurrent Pansinusitis and Orbital Cellulitis Complicated by Extensive Head and Neck Venous Thrombosis in an Unvaccinated Adolescent Patient with COVID-19: A Case Report.

BACKGROUND: Orbital cellulitis is an infrequent but serious infectious complication of rhinosinusitis, most commonly seen in the pediatric population. Extension into the cavernous sinus, leading to further infection and thrombosis, is a rare but life-threatening complication. Although COVID-19 has been linked to an increased risk of venous thromboembolism, most cases involve extremity deep venous thrombosis or pulmonary embolism; reports of intracranial or jugular system thrombosis are rare. CASE REPORT: We describe a case of a 17-year-old female patient with no significant medical history or thrombotic risk factors found to have orbital cellulitis and severe pansinusitis, complicated by multiple venous thromboses in the head and neck requiring emergent surgical intervention and pediatric intensive care admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Extensive head and neck venous thrombosis and intracranial abscesses are rare complications of pansinusitis and orbital cellulitis, and the thrombotic complications of COVID-19 are well documented. A delay in diagnosis and treatment can lead to potentially devastating consequences.

Isolated Right Internal Jugular Vein Thrombosis: a Rare Complication of Acute Pancreatitis - a Case Report.

Vascular complications particularly splanchnic vein thrombosis can occur in acute as well as chronic pancreatitis, but extra-splanchnic thrombosis occurs rarely. We report a rare case of acute pancreatitis complicated by isolated internal jugular vein thrombosis. A 26-year-old Indian woman presented with complaints of severe epigastric pain radiating to the back, vomiting, and abdominal distension. Investigations showed low hemoglobin and serum calcium, and a raised serum amylase and lipase. Contrast-enhanced computerized tomography (CECT) of the abdomen suggested acute pancreatitis with bilateral pleural effusion and mild ascites. The patient was managed for acute pancreatitis with antibiotics, analgesics, pantoprazole, and other supportive treatment. She subsequently developed pain and swelling on the right side of the neck. Ultrasound Doppler examination of the neck revealed an isolated thrombus in the right internal jugular vein (IJV). The patient was started on enoxaparin and transitioned to warfarin. The patient improved symptomatically and was discharged on warfarin. A follow-up ultrasound Doppler examination showed a partial resolution of the clot. The patient was maintained on oral anticoagulants for 6 months. Isolated IJV thrombosis may complicate acute pancreatitis. A timely diagnosis and prompt treatment are critical for a positive outcome.

Atypical Lemierre's Syndrome. A Case Report and Review of Literature.

Lemierre's syndrome (LS) is a rare disease entity, which can be catastrophic if organism-directed treatment is not initiated early. Lemierre's syndrome is frequently caused by Fusobacterium infection which is frequently susceptible to clindamycin. Evidence suggests there is an increase in the incidence of cases of drug resistant Fusobacterium species. Through this case we present a unique case of a 45-year-old Caucasian female with Lemierre's Syndrome due to polymicrobial organisms that were resistant to clindamycin thus developing recurrent infections despite being on antibiotics.

Trauma to Thrombus: A Case Report of Internal Jugular Vein Thrombosis.

Internal jugular vein (IJV) thrombosis is associated with several etiologies. Trauma is a rarely recorded causative factor. This case presents one such example of how trauma causes IJV thrombosis. A middle-aged woman presented to the general medicine outpatient department with complaints of pain in the base of the left side of the neck and swelling of the left arm and neck for six days. The symptoms had occurred following a trivial trauma to the left side of the neck due to pressure from a 25 L water can. Before the patient came to our hospital, she went to a local clinic, where magnetic resonance imaging was done and showed findings suspicious of thrombosis in her left IJV with extension into adjacent veins. A venous Doppler confirmed the findings. The patient was then treated conservatively with low-molecular-weight heparin, muscle relaxants, and antibiotics. Although uncommon, vascular injuries should also be thought of following minor trauma and not just musculoskeletal events. This case report proposes that IJV thrombosis can also occur without the classical etiological factors.

Central venous catheter-related thrombosis in pediatric surgical patients: A prospective observational study.

BACKGROUND: Perioperative central venous catheters are required but may be associated with various complications. AIMS: The purpose of our study was to assess the incidence and perioperative risk factors for catheter-related internal jugular vein thrombosis in pediatric surgical patients. METHODS: This prospective observational study included children under 6 years of age who were scheduled to undergo central venous catheterization of the right internal jugular vein under general anesthesia. A central venous catheter was inserted under real-time ultrasound guidance. An investigator examined for thrombosis using ultrasonography at predetermined time points. The primary aim was the incidence of catheter-related thrombosis from insertion until the 5th day postoperatively or the removal of the central venous catheter. The secondary aim was the determination of the risk factors for thrombosis. RESULTS: Eighty patients completed the study. Internal jugular vein thrombi were found in 31 patients (38.8%, 95% CI 28.0-49.4). On multiple logistic regression analyses, the number of insertion attempts was the only influencing factor for catheter-related thrombosis (p < .001). More than two insertion attempts increased the risk of thrombosis (odds ratio 5.6; 95% CI 1.7 - 18.7, p = .004). Anesthesia time (p = .017; mean difference 166.4 min; 95% CI 55.7-277.1), intraoperative red blood cell transfusion (p = .001; median difference 21.1 ml kg-1 ; 95% CI 6.6-34.4), and intensive care unit stay (p = .001; median difference 100.0 h; 95% CI 48-311) differed between patients with transient thrombosis and those with thrombosis lasting for more than 3 days. CONCLUSION: Internal jugular vein thrombosis was frequently detected by ultrasound following central venous catheterization in pediatric surgical patients. Multiple insertion attempts may be associated with the incidence of thrombosis. The clinical relevance of thrombi detected via ultrasound surveillance has not been determined.

Metastatic carcinoma of the lung presenting as jugular venous thrombosis: a valuable clinical lesson.

Thromboses of the upper extremity and neck are rare and not as commonly seen as lower extremity deep vein thrombosis (DVT). Internal jugular vein thrombosis (IJVT) is a serious condition with a potentially fatal outcome. Jugular vein thrombosis refers to the formation of intraluminal thrombi anywhere from the intracranial part of the jugular vein to the junction between the internal jugular vein (IJV) and subclavian vein. The relationship between malignancy and thromboembolic disorders has been well established, as Trousseau first described it in 1865. Tumor cells are known to promote hypercoagulability by expressing tissue factors that activate clotting cascades and procoagulants while promoting interactions between the tumor cells, platelets, and endothelial cells via different cytokines, tumor antigens, and their immune complexes. We are reporting our encounter with a patient who presented with extensive left internal jugular vein thrombosis as the first presenting sign of primary lung malignancy.

Central Vein Thrombosis in Pulmonary Neuroendocrine Neoplasm: A Novel Presentation.

Internal jugular vein (IJV) thrombosis is a rare finding and is usually associated with central venous catheterization, neck infections, or local trauma. Neuroendocrine tumors (NETs) rarely predispose to central vein thrombosis. The usual presentation of pulmonary NET depends on tumor location and is usually non-specific. It ranges from asymptomatic to cough, hemoptysis, dyspnea, etc. Here we present the case of a 52-year-old male with right-sided neck swelling. Ultrasound imaging of the neck revealed right IJV and right subclavian vein thrombosis. Further imaging with computed tomography (CT) scan of the chest showed mediastinal mass. Histopathology findings were consistent with NET of pulmonary origin. Patient was started immediately on anti-coagulation and radiology oncology was consulted for tumor-specific treatment. This case highlights an association of central vein thrombosis with underlying mediastinal and lung malignancies.

Internal Jugular Vein Thrombosis: Unusual Diagnosis of a Cervical Mass.

Idiopathic internal jugular vein thrombosis (IJVT) is a rarity that we must quickly identify and manage, as it may have severe consequences such as cerebral venous sinus thrombosis (CVST). CVST might be fatal unless it is managed promptly. However, due to its rarity, clinicians are often unfamiliar with the presentation of this pathology. We report an unusual finding of IJVT in a 53-year-old female patient who presented with a cervical mass on the left side to our otolaryngology outpatient clinic. A cervical ultrasound and computed tomography (CT) confirmed the diagnosis of IJVT. An extensive workout ruled out thrombophilia, CVST, cardiovascular diseases, head and neck cancers, and urinogenital tract neoplasms. The symptoms resolved under treatment with anticoagulation.

Intracranial hypertension syndrome secondary to internal jugular vein thrombosis due to miliary cervical tuberculosis: A case report.

BACKGROUND: Thrombosis of the internal jugular vein (IJV) is extremely rare, being central catheterization the most common cause. We present a case of a patient with an unusual appearance of neurological symptoms as a consequence of thrombosis of the IJV secondary to miliary tuberculosis. CASE DESCRIPTION: A 30-year-old woman with disseminated tuberculosis, with multiple lymphadenopathy, axillary, cervical, mesenteric, retroperitoneal, and inguinal, presented with clinical evidence of intracranial hypertension. A diagnostic cerebral angiography was performed, which revealed an occluded left internal jugular and venous stasis in the entire cerebral venous system. The patient was treated with low-molecular-weight heparin, with which she had an adequate evolution. CONCLUSION: Tuberculosis is capable of generating a state of hypercoagulability, in addition to a mechanical compression effect due to cervical lymphadenopathy. We report an unusual clinical presentation, with intracranial involvement due to IJV thrombosis secondary to miliary tuberculosis. So far, there are no cases with a similar presentation described above.

Lemierre's syndrome in adulthood, a case report and systematic review.

Introduction: Lemierre's syndrome is a septic thromboembolic complication of an oropharyngeal or neck infection, primarily caused by Fusobacterium species. Although it usually affects young healthy patients, some case reports describe this syndrome in older population.Methods: A case report and a systematic review of the literature were conducted to investigate the late onset of Lemierre's syndrome. Forty-one articles were selected for the qualitative analysis, 39 for the quantitative analysis.Results: The average age of the study population was 52 years old. Diabetes mellitus and upper gastro-intestinal malignancy, common comorbidities in the study population, might play a role in the development of late-onset Lemierre's syndrome. Empiric antibiotic treatment should cover Fusobacterium and Streptococcus species both, which may cooperate to induce purulent disease. Reported unfavourable outcome was more than expected.Conclusion: Lemierre's syndrome in adulthood may differ from the usual version. This disease may further pass unrecognized, if presented out of the expected age range. Nevertheless, early diagnosis and prompt treatment are a requisite to prevent morbidity and mortality, which may be higher in this older population.

Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery.

BACKGROUND: Free flap failure secondary to internal jugular vein thrombosis (IJVT) is a significant complication after head and neck reconstructive surgery. A consensus has not yet been reached among reconstructive surgeons regarding the treatment of IJVT. METHODS: We retrospectively evaluated the incidence of IJVT in 118 patients who underwent free flap reconstruction at Hyogo Cancer Center, Akashi, Japan. The occurrence of IJVT-related flap circulation crisis and pulmonary thromboembolism (PTE) was studied. This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient. RESULTS: From 118 patients who underwent head and neck reconstructive surgery, we included 116 internal jugular veins (IJVs) preserved after neck dissection in the present study. IJVT was confirmed in 25 (21.6%) IJVs from 23 patients. One patient (0.8%) developed venous congestion due to IJVT, which resulted in total flap necrosis. Two patients (1.7%) exhibited PTE associated with IJVT. They were treated with direct oral anticoagulants for 3 months and were discharged without any sequelae. CONCLUSION: Our results suggest that IJVT after head and neck reconstructive surgery caused not only flap circulation crisis but also PTE. Reconstructive surgeons should be aware of the potential risks due to serious complications associated with IJVT.

[Cervicofacial cellulitis complicated by internal jugular vein thrombosis]. / Cellulite cervico-faciale compliquée d'une thrombose veineuse jugulaire interne.

INTRODUCTION: Cervicofacial cellulitis (CFC) is one of the most common dermatological infectious emergencies, and related morbidity and mortality are non-negligible. PATIENTS AND METHODS: We describe the case of a 31-year-old male with left parotitis complicated by CFC with worsening over the previous week despite treatment with clindamycin and non-steroidal anti-inflammatory drugs. A cervicofacial computed tomography (CT) scan showed left internal jugular vein thrombosis (IJVT). Chest imaging showed no pleuropulmonary lesion, and bacteriological samples were negative. The patient received broad-spectrum antibiotic therapy and anticoagulants for 6 weeks. The outcome was quickly favourable. DISCUSSION: It is essential to perform a cervicofacial contrast-enhanced CT scan for any CFC to map the affected areas, detect the primary infection and screen for loco-regional complications such as IVJT. The occurrence of IJVT in an infectious setting should prompt screening for septic emboli, especially pulmonary emboli, as well as performance of a chest CT scan. The presence of septic emboli associated with a recent ENT infection and of IJVT or Fusobacteriumnecrophorum in blood cultures are indicative of Lemierre's syndrome. CONCLUSION: IJVT is an uncommon complication of CFC that occurs either alone or as part of Lemierre's syndrome.

A Rare Case of Lemierre's Syndrome Caused by Streptococcus Intermedius, Presenting as an Epidural Abscess.

Lemierre's syndrome is a rare but life-threatening condition characterized by an oropharyngeal infection typically secondary to Fusobacterium necrophorum resulting in septic thrombophlebitis of the internal jugular vein. Streptococcus intermedius is a particularly rare cause of Lemierre's syndrome with only a few cases reported in the literature. Here we describe a rare case of Lemierre's syndrome, caused by Streptococcus intermedius, likely secondary to an odontogenic infection, found to have a cervical epidural abscess with concomitant large retropharyngeal and prevertebral abscesses on presentation, in whom the clinical course was further complicated by an extensive cerebral venous sinus thrombosis. However, despite grave complications, early diagnosis and appropriate emergency management including intravenous antibiotics and surgical intervention led to a successful recovery, thus demonstrating that aggressive measures can potentially lead to a favorable outcome.

Case of internal jugular vein thrombosis and fever: Lemierre's syndrome or Trousseau's syndrome?

Internal jugular vein thrombosis is a rare critical cardiovascular emergency, which has potential catastrophic clinical outcomes by resulting in stroke and pulmonary embolism. Several etiologies have been reported; however, there are limited data on Lemierre's and Trousseau's syndromes, which are both rare conditions with advanced disease progression and poor clinical outcomes. Lemierre's syndrome may present with typical progressively infectious symptoms and signs, including sore throat, neck mass, and fever, whereas Trousseau's syndrome may present with thrombophlebitis and painful edema. Without antibiotic agents controlling the infection, the condition of patients with Lemierre's syndrome may progress to sepsis or septic shock. The infection pattern plays an important role for differential diagnosis. Herein, we describe the case of a 46-year-old woman presenting with atypical symptoms of Trousseau's syndrome mimicking Lemierre's syndrome. Laboratory analysis including protein C, protein S, rheumatoid factor, and antinuclear antibody ruled out hypercoagulopathy and autoimmune vasculitis. Abdominal computed tomography and panendoscopy revealed ulcerative tumor at the antrum. Pathological examination confirmed the presence of signet-ring cell adenocarcinoma. We highlight the clinical features and etiologies of internal jugular vein thrombosis, especially in Lemierre's syndrome and Trousseau's syndrome, to aid physicians in making an early diagnosis and providing timely management.