Kumar Manoj, Singh Ragini, Sawlani Kamal Kumar, Kumar Santosh
Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India.
BMJ Case Rep. 2013 Jan 22;2013:bcr2012007647. doi: 10.1136/bcr-2012-007647.
A 51-year-old male patient presented with breathlessness for 10 days. Chest radiograph revealed bilateral moderate pleural effusion. Ultrasound-guided diagnostic pleural aspirate revealed sterile transudative fluid. CT thorax revealed bilateral moderate pleural effusion with partial collapse of both lower lobes and thrombus in right brachiocephalic vein. Two-dimensional-echo revealed circumferential pericardial effusion with mild pericardial thickening and moderate tricuspid regurgitation. Cardiolipin antibodies were within normal limits. d-Dimer assay and C reactive protein were markedly raised. During the period of investigations, the patient had developed mild swelling and pain in right upper limb for which colour Doppler ultrasonography of his right upper limb and neck regions were done. Thrombi in right internal jugular, subclavian and brachiocephalic veins were noted. CT angiography, CT abdomen and chest confirmed the above findings. However, extent of the thrombus and lung lesions was better delineated by CT angiography. We have highlighted the pathognomonic imaging findings of Lemierre syndrome.
一名51岁男性患者因气促10天前来就诊。胸部X线片显示双侧中度胸腔积液。超声引导下诊断性胸腔穿刺抽出无菌性漏出液。胸部CT显示双侧中度胸腔积液，双下叶部分肺不张，右头臂静脉血栓形成。二维超声心动图显示心包环形积液，心包轻度增厚，三尖瓣中度反流。心磷脂抗体在正常范围内。D-二聚体检测和C反应蛋白明显升高。在检查期间，患者右上肢出现轻度肿胀和疼痛，为此对其右上肢和颈部进行了彩色多普勒超声检查。发现右颈内静脉、锁骨下静脉和头臂静脉血栓形成。CT血管造影、腹部和胸部CT证实了上述发现。然而，CT血管造影能更好地显示血栓和肺部病变的范围。我们重点介绍了勒米尔综合征的特征性影像学表现。
