Preliminary Diagnosis: Lemierre's Disease

I. What imaging technique is first-line for this diagnosis

  • CT of the neck with IV contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of Lemierre's disease.

Advantages

  • Quick imaging modality that offers exquisite visualization of the tonsillar tissues and vascular structures

  • More sensitive and specific in diagnosing an underlying primary process, and characterizing and detecting any secondary complications

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  • Better for evaluating for any secondary evidence of pulmonary embolism compared to other imaging modalities

  • Can characterize the extent of vascular invasion from thrombophlebitis

  • May help evaluate for any intracranial extension of infection

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR imaging of the neck with contrast and MRV of the neck and head

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Lemierre's disease.

MR imaging of the neck with contrast and MRV of the neck and head
Advantages

  • Does not expose patients to ionizing radiation

  • Better to evaluate for any intracranial complications than other imaging modalities

Disadvantages

  • Expensive

  • Time-consuming

  • Less sensitive and specific in visualizing and diagnosing venous thrombosis compared to companion CT imaging

  • Less adept in detailing any primary tonsillar infection or evidence of pharyngitis compared to CT imaging

  • May be subject to motion artifact and susceptibility weighted artifact degrading image quality

VI. What are the contraindications for the alternative imaging techniques?

MR imaging of the neck with contrast and MRV of the neck and head

  • Contraindicated in patients with non-MR compatible hardware

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