CTICasesLemierre's Syndrome with Mediastinal Abscess and Septic Emboli in an Infant
Imaging findings
CT of the neck and chest in a septic four-month-old infant reveals a large filling defect in the internal jugular vein representing thrombophlebitis, extensive necrotic cervical and mediastinal lymphadenopathy, and separate fluid collections representing an anterior mediastinal abscess. Subsequent chest CT demonstrates thin-walled peripheral pulmonary nodules with central necrosis, consistent with septic emboli, alongside a pleural empyema.
Key takeaways
Lemierre's syndrome is characterized by internal jugular vein thrombophlebitis and metastatic septic emboli, typically following a primary pharyngeal or upper airway infection. Although classically caused by Fusobacterium necrophorum in young adults, the syndrome can occur in infants due to other pathogens such as Staphylococcus aureus, leading to severe, rapid-onset complications like mediastinal abscesses and empyema.
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