Lemierre syndrome

From Otolaryngology Online

Is defined as suppurative thrombophlebitis of internal jugular vein.


This syndrome is caused by extension of infection into the carotid space. source of infection could be any of the deep neck space infections.

Clinical features:

1. Swelling and redness over the angle of the jaw and along the sternocleidomastoid muscle

2. Spiking fevers

3. Chills

4. Evidence of pulmonary embolism.


High index of suspicion is necessary.

1. High resolution ultrasonography

2. CECT scan (contrast enhanced computerized tomography)

3. MRI / MRA


Prolonged course of antimicrobial therapy. The choice of drug is dependent on culture / sensitivity results.

Anticoagulants are recommended for 3 months when there is evidence of thrombus progression / evidence of septic emboli.

Fibrinolytics can be prescribed if this syndrome is recognized within 4 days of onset.

Surgical ligation / resection of internal jugular vein is reserved for patients with evidence of septic pulmonary emboli not resolving to medical management.

Endovascular stenting / superior vena cava filters can also be considered.

Dangers of Lemierre syndrome:

Carotid aneurysm

Septic pulmonary emboli