What is the most likely diagnosis? 
              
- 14 year-old female with left facial pain and edema

  
  Gray-scale  and color Doppler images of  left internal jugular vein
            
              
              
                - Hansen's Disease
- Atherosclerotic plaque
- Venous Dissection
- Lemierre Syndrome
- Lymphoma
Additional Images - Axial,  sagittal and coronal images from a contrast-enhanced CT scan of the neck
            
             
            
               
              Additional Images
               
              
              Axial,  sagittal and coronal images from a contrast-enhanced 
              CT scan of the neck
              
             
            
              
                  Answer:
               
              
                4. Lemierre Syndrome
                 
              
              More (Click Discussion Tab) 
             
            
               
               
              Lemierre Syndrome
                
              
              General Considerations
              
                - Seen in young adults who may be       otherwise healthy 
- Refers       to rare thrombophlebitis of the internal jugular vein with       distant metastatic sepsis seen in the setting of initial oropharyngeal       infection (pharyngitis / tonsillitis with or without peri-tonsillar       abscess
- More       common in pre-antibiotic era
                    
                      - 90%  mortality before antibiotics
 
- Most       common pathogen is Fusobacterium necrophorum