WIDI - CA0125-Pharyngitis with Tonsillitis & Lemierre, CT

History

24-year old male with throat pain and fever and possible aggressive pharyngitis, tonsillar or peritonsillar, infection/ abscess.

Exam

Contrast-enhanced CT of the maxillofacial region and neck and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures as well as possible reactive changes around infected collections. 0.5-3.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Findings

Nasopharynx Including Retropharyngeal Lymph Nodes

The lymphoid tissue in the nasopharynx is somewhat hypertrophic consistent with the patient’s age. There is no significant parapharyngeal edema.

Oropharynx

There is inflammation of the palatine and lingual tonsillar tissue as well as the lymphoid tissue along the glossotonsillar sulci and posterior pharyngeal wall.

There is no evidence of tonsillar or peritonsillar abscess with edema in the adjacent left parapharyngeal space and the retrostyloid compartment.

Retropharyngeal Lymph Nodes

There is no reactive or suppurative retropharyngeal lymphadenopathy.

Hypopharynx, Larynx, Deep Neck and Entire Retropharyngeal Space

There is extensive edema within the adjacent deep neck especially in the prevertebral and paravertebral spaces with a lesser degree of retropharyngeal edema.

Vascular Findings

There is evidence of thrombus/occlusion of the left jugular vein. The right internal jugular vein is patent.

Cervical Lymph Nodes

There is reactive cervical lymphadenopathy in level 2, 3 and 5 on the left and less prominent adenopathy in level 2 on the right.

Upper Lung Zones and Mediastinum

The upper lung zones and mediastinum visualized are normal.

Other Findings

There are inconsequential retention cysts in the both maxillary sinuses with mucoperiosteal thickening without aggressive features in the right maxillary sinus.

Impression

Pharyngitis and tonsillitis without abscess with a complete thrombosis of the left internal jugular vein raising the probability of anaerobic infection and risk of systemic Lemierre syndrome.

Recommendations

The treating EMS physician was contacted verbally immediately upon completion of the study because of the potentially highly aggressive nature of the infection due to the associated jugular thrombosis and therefore potential life-threatening complications of systemic manifestations of Lemierre syndrome.

Acuity

Emergent: non-routine communication required immediately or within 30 minutes