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BMJ Case Reports 2017; doi:10.1136/bcr-2017-223371
  • Unusual association of diseases/symptoms
  • CASE REPORT

Variant of Lemierre’s syndrome with internal jugular vein aneurysm

  1. Yuan Hwen Liew3
  1. 1Department of Medicine, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
  2. 2Radiology Department, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
  3. 3Department of Diagnostic Imaging, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia
  1. Correspondence to Sidney Ching Liang Ong, sidney_ong{at}yahoo.co.uk
  • Accepted 11 December 2017
  • Published 22 December 2017

Summary

Internal jugular vein (IJV) aneurysm is a rare entity, and a thrombosed aneurysm poses diagnostic and management challenges. We came across a 53-year-old woman who presented with fever, vomiting and right neck swelling for a week. Laboratory investigations showed neutrophilic leucocytosis, raised acute phase reactant and blood culture yielded Klebsiella pneumoniae. Ultrasound and contrast-enhanced CT neck revealed a large fusiform aneurysm of the right IJV with filling defect extending from the aneurysm into the right transverse sinus. There was a cavity at the right lower third molar tooth. MRI confirmed the findings with additional enhancing focus at right lower periodontal region. The swelling reduced after 2 weeks of medical therapy, and follow-up imaging 4 months later showed complete resolution of the aneurysm with residual thrombosis. After extensive workup, dental infection remains the only identifiable primary source leading to thrombophlebitis of the right IJV and subsequent sequelae.

Footnotes

  • Contributors The authors SHC, SCLO and YHL have contributed sufficiently to the project and have met all criteria to be included as authors.

  • Disclaimer All authors have no relevant financial interest in this manuscript and no activities, affiliations or relationships to disclose. All authors have not published or submitted any related papers from the same study.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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