Thrombophlebitis Of The Internal Jugular Vein – “EM Quick Hits 8 Lemierre’s Syndrome From Emergency Medicine Cases

Please see also Links To And Excerpts From “Lemierre’s Syndrome: Recognising a Typical Presentation of a Rare Condition”
Posted on October 28, 2019 by Tom Wade MD

This post contains a link to and the show notes from EM Quick Hits 8 Lemierre’s Syndrome (0:33-6:19) [Link is to the show notes and podcast] from Emergency Medicine Cases.

Here are the show notes for this section of the podcast:

Lemierre’s Syndrome Clinical Clues

  • Lemierre’s syndrome is a rare, life-threatening diagnosis most commonly seen in children and young adults. It is thrombophlebitis of the internal jugular vein with bacteremia, often fusobacterium.
  • Patients will frequently be toxic at the time of diagnosis and can have “metastatic” lesions from septic emboli – pneumonia, meningitis, bacteremia, septic joints etc. as well as cranial nerve abnormalities
  • Consider the diagnosis in patients with prolonged pharyngitis (>7 days), a history of pharyngitis that improves and then worsens, septic patients with pharyngitis, those with pharyngitis and a second infection (pharyngitis “+1”), and those with signs of deep space infection such as trismus, pain on rotation of the neck, or palpable neck mass.
  • Diagnosis is typically made by CT of the neck with contrast.
  • Treatment is with broad spectrum antibiotics such as peperacillin-tazobactam or ampicillin-sulbactam usually in the ICU.
  • Treatment of all patients with simple pharyngitis with antibiotics does not prevent the development of Lemierre’s.

Podcast production, editing and sound design by Anton Helman

Podcast content & blog post by Anand Swaminathan, Brit Long, Emily Austin & Sucheta Sinha, edited by Anton Helman

Topics in this EM Quick Hits podcast

Anand Swaminathan on Lemierre’s syndrome (0:33)

Emily Austin on clonidine toxicity (06:20)

Brit Long on myths of routine coagulation panel testing (11:48)

Hans Rosenberg and Michael Ho on reversal of anticoagulation (17:22) *

Sheldon Cheskes on mechanical CPR (24:00)

*CJEM collaboration quick hit, reviewing ‘Just the Facts’ series

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