Recruitment lecture 01.10.20

Today for conference we presented a young patient with fever and sore throat who developed pleuritic chest pain and dyspnea, on chest imaging they had bilateral pulmonary abscesses. After discussing the differential for pulmonary abscesses (not only infectious) we discussed red flags in patients with sore throat (airway, deep cervical and chest symptoms). After blood culture grew fusobacterium necrophorum, the patient was diagnosed with Lemierre’s syndrome – suppurative thromboplebitis of the internal jugular vein. lung abscess – 1.10

Take home points:

  • There is a broad differential for cavitary lung lesions aside from lung abscesses due to infection
  • Lung abscesses are most commonly caused by oral flora and can be from direct inoculation or contiguous spread
  • Deep cervical space infections can be life threatening, often happening in young healthy adults
  • Warning signs include airway, neck and pulmonary symptoms as well persistent fevers / bacteremia
  • The treatment of most of these infections includes treatment of initial infection, surgical drainage and antibiotics. Use of anticoagulation in Lemierre’s syndrome is controversial

 

AS

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