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Hi
I had got a patient where I had suspected Lemiere syndrom – made ultrasound of IJV – what I found was a little bit strange – it didn’t look like typical venous thrombosis – but in longitudinal view I tried to find the wall of the vein and it was smth inside – I checked with Doppler and it looked like dvt. I found it in place when ijv start to bifurcate – very early I saw two vein (on the other site the picture was different). Make the story short – I send her to radiologist to confirm it – she came back and told me that it was a lymph node.
So my question is – what should I do to confirm or exclude my diagnosis – so any specific sign? If lymph node mimic dvt- is there any characteristic sign? -
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Hi Leszec,
What a fascinating case.
Indeed it does look like thrombus within the internal jugular vein.
I would love to see a short axis “axial” image or video if you have one.
I can’t think of a condition where there would be a lymph node within the IJV.
But there are plenty of options to consider.
If it is Lemiere syndrome the patient should be unwell with a nasty bacterial pharyngitis or tonsilitis.
How did the patient present?
If it was a lymph node I would suggest it is adjacent to the IJV and may be extrinsically compressing the IJV to create an appearance of something within the IJV.
If it is a lymph node I would expect it to be oval shaped and have an echogenic fatty hilum and a hilarious flow pattern with Doppler. If it is a node I would expect multiple nodes rather than a solitary one.
You can certainly get a DVT style thrombus in the IJV, so this is a possibility.
Then we have a few other options.
With thyroid cancer there can be direct extension via the middle thyroid vein of tumour thrombus into the IJV.
There is also a variety of primary vein wall tumours to consider.
It could be Intravenous pyogenic granuloma (IVPG) which is a subset of lobular capillary haemangioma.
These can certainly be within the IJV.
The wonderful Quanson Sirlyn is going to publish a case study on this topic soon and once it is completed I will upload it to the “articles” tab on this website for you to enjoy.
There is also other vein wall mass possibilities.
Steve.
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Hi
Thank you very much.
I wasn’t sure what to make of it first – she didn’t look too bad, but she went to the ER and came back the next day because she felt worse – and still complained of a sore throat, neck, and numbness. No fever, one tonsil enlarged (but nothing serious) – on antibiotics and NSAIDs (in the emergency room she had a fever and general malaise). I have only met one patient with Lemiere’s syndrome in the past – the patient was in a really bad condition.
I don’t have any more photos – I forgot to save them.
I’ve been going over it in my head and I think it’s lymph node pressure – according to the information you gave me.
SO thank you again -
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Hi
She was back for follow up – antibiotic is finished but still has pain in the neck – 3 /10, no fever all rest parameters are ok. I did ultrasound – the transverse view this time was recorded, longitudinal view was the same like last time.
Pain in the neck – compression of superficial cervicalplexus by lymph node ? -
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Hi Leszek,
Nice videos,
The short axis helps a lot to get a perspective.
Now to me it just looks like a normal cervical lymph node.
I would not have worried about it personally.
It seems adjacent to the internal jugular vein rather than within it and you can see a few other adjacent benign looking nodes.
The node is oval shaped and has a normal echogenic hilum.I would be surprised if this is the source of the pain.
The vagus nerve is right next to it, but appears normal.
Steve.
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