A 65-year-old female presented with symptoms of tonsillitis and sepsis. Despite
initial treatment with i.v. fluid and antibiotics, her condition deteriorated
and she became hypoxaemic. CT pulmonary angiography showed no filling defects in
the pulmonary arteries, but there were multiple cavitating lung nodules,
initially thought to represent metastases. A subsequent contrast-enhanced CT of
the neck and thorax demonstrated thrombosis of the left external jugular vein
(EJV), leading to a revised diagnosis of Lemierre’s syndrome
(
i.e.
septic embolization from jugular thrombophlebitis).
Noteworthy aspects of the case include the initial misdiagnosis of the
cavitating lung nodules by the reporting radiologist and the isolated
involvement of the EJV—Lemierre’s syndrome usually involves the
internal jugular vein. The case highlights the importance of septic emboli in
the differential diagnosis of cavitating lung nodules, and of assessment of the
EJV as well as internal jugular vein in the context of oropharyngeal
infection.