Imaging
Lemierre's Disease
- Preliminary Diagnosis: Lemierre's Disease
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of Lemierre's disease.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Lemierre's disease.
- VI. What are the contraindications for the alternative imaging techniques?
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
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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