It's A Pain in The Neck: Case Report of Bedside Diagnosis of Unilateral Neck Swelling.

introductionLemierre syndrome is a rare but potentially severe thrombophlebitis of the internal jugular vein. It most often presents after oropharyngeal infection, likely stemming from anaerobic bacteria, commonly Fusobacterium necrophorum. The potential severity of this condition underscores the importance of early and accurate diagnosis. The gold standard diagnosis relies on computed tomography and blood cultures; however, point-of-care ultrasound offers a rapid and cost-effective tool. CASE REPORT: A 58-year-old woman with chronic obstructive pulmonary disease, migraines, and recent dental extractions presented with two days of worsening right-sided neck pain and swelling. She denied fever, chills, or recent upper respiratory symptoms. Examination revealed a tender anterior neck mass without airway compromise. Point-of-care ultrasound demonstrated a 1.22 x 1.80 centimeters hyperechoic intraluminal mass within the right internal jugular vein with surrounding cobblestone edema; the external jugular vein and carotid artery were normal. Computed tomography imaging confirmed the diagnosis. Laboratory studies were unremarkable. Blood cultures were obtained, and empiric intravenous beta lactamase-resistant antibiotics was initiated. Anticoagulation was considered but not started.

conclusionA delayed diagnosis of Lemierre syndrome is common, as its early presentations are commonly nonspecific. The classic triad is a recent oropharyngeal infection, internal jugular vein thrombosis, and septic emboli. The importance of early diagnosis and treatment cannot be overstated, as it improves outcomes while reducing costs and radiation exposure for the patient. Point-of-care ultrasound is a valuable first-line imaging modality for Lemierre syndrome. Its use in patients with symptoms such as unexplained neck swelling and tenderness can facilitate timely diagnosis and treatment, thereby averting serious adverse outcomes.