Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan.
J Postgrad Med. 2024 Jan-Mar;70(1):50-52. doi: 10.4103/jpgm.jpgm_722_22.
We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.
我们报告了一例 19 岁女性莱姆病综合征患者，其表现为发热、咽痛和左肩痛。影像学检查显示右侧颈内静脉血栓形成，双侧胸腔下多个结节影，部分有空腔，右肺坏死性肺炎，脓胸，肩胛下肌脓肿和左髋关节多房性积液。在为脓胸插入胸腔引流管并给予尿激酶治疗后，怀疑存在支气管胸膜瘘。根据临床症状和计算机断层扫描（CT）扫描结果确定了瘘管的存在。如果存在支气管胸膜瘘，不应该进行胸腔灌洗，因为这可能会导致反流引起的对侧肺炎等并发症。
