see also: [[Ludwig angina]], [[Parapharyngeal abscess]] see: [Dunn - conditions of the head and neck](x-devonthink-item://312F4614-E0B2-4363-B2D5-2C2D7641D041), [Hayes' Jugular venous thrombosis](x-devonthink-item://52C46EB7-1F05-41CF-A7B2-F9EB46370537), [Rosen - odontogenic and deep neck infections](x-devonthink-item://645728DB-4B36-44DC-A117-83B80B325B16?page=5) ## Overview - septic thrombophlebitis to internal jugular vein - due to an adjacent acute oropharyngeal infection - spread is from the posterior compartment of the parapharyngeal space - commonly complicated by metastatic pulmonary and CNS infection - consider in patients with pulmonary abscesses who have no other risk factors for right-sided endocarditis **organisms** - fusobacterium necrophorum and Prevotella - aggregates human platlets without lysing them **clinical features** - septicaemia may uccur up to a week after the oropharyngeal infection ## Features - initial sx most commonly sore throat or neck pain - pain, swelling, and induration at the angle of the mandible and along the sternocleidomastoid muscle may be present - thrombosis may have resolved in late presentations - internal jugular vein thrombosis can extend to involve the cavernous sinus ## investigations - CXR / CT chest for detection of septic emboli - blood cultures - [[DIC]] screen - thrombocytopenia common - ultrasound of IJV - CSF may contain inflammatory cells ## Treatment - abx: - penicillin - metronidazole - clindamycin - chloramphenicol - generally use beta lactamise resistant abx with anaerobic activity - systemic anticoagulation - source control