ABSTRACT
Lemierre syndrome describes septic thrombophlebitis of the internal jugular vein (IJV) and metastatic spread of the infection following a recent oropharyngeal infection in a setting of bacteremia caused by Fusobacterium necrophorum. Lemierre-like syndrome describes similar clinical scenario with no preceding oropharyngeal infection and/or in the setting of non-Fusobacterium cause. We report a case of Lemierre-like syndrome in a setting of Enterobacter cloaca bacteremia without known preceding oropharyngeal infection. History and physical exam revealed an irritable infant with cough, tachypnea, low grade fever, bilateral lung crepitations and features of infantile seborrheic dermatitis on the scalp. Imaging revealed thrombosis of right internal jugular vein and superior vena cava, bilateral pulmonary cavitary lesions and collections consistent with septic pulmonary emboli. Multiple rim enhancing hypo-dense liver lesions and chest wall collections consistent with abscesses were also seen. He was managed with parental antibiotics, drainage of the chest wall abscesses and discharged with clinical and radiologic improvement.
ABSTRACT
Right-sided aortic arch, first documented by Fioratti and Aglietti in 1763, is a rare variant of the thoracic vascular anatomy present in about 0.1% of the adult population. In half of these cases the left subclavian artery is also aberrant. The aberrant left subclavian artery usually originates from a conical dilatation near its origin from the aorta also known as "Kommerell's diverticulum." Fewer than 80 of these cases have been reported in the literature as far as our web search is concerned. It is usually asymptomatic and diagnosed incidentally during adulthood. We are presenting a 56 years old male patient presented with right side chest and shoulder pain of 1 week duration. The pain exacerbated with motion of the right upper extremity and radiates to his lower back. However, he had no history of cough, shortness of breath, syncope, and dysphagia. The vital signs were in normal range. Pulmonary and cardiovascular exam were unremarkable. The complete blood count (CBC), electrocardiogram (EKG), and echocardiography showed no abnormality. In the adult population a right-sided aortic arch with an aberrant left subclavian artery arising from Kommerell's diverticulum is a rare occurrence often asymptomatic unless aneurysmal disease or compression of mediastinal structures ensues. Even though it is rare and at times an incidental finding, the condition is clinically relevant because of the morbidity caused by the complications. We report a case of Kommerell's Diverticulum of an aberrant left subclavian artery in an adult patient with a right-sided aortic arch. Right-sided aortic arch with aberrant left subclavian artery arising from Kommerell's Diverticulum is quite rare and may remain asymptomatic. On times it may cause symptoms in adulthood often as a result of early atherosclerotic changes of the anomalous vessels, dissection, or aneurysmal dilatation with compression of adjacent structures causing dysphagia, dyspnea, cough, or chest pain. Even though there are no general guidelines for the management of this condition patients need to be informed about the nature and possible outcomes of their condition. Close follow up of asymptomatic patients is one option of management until there are situations which require consideration of surgical intervention.
ABSTRACT
Esophageal cancer (EC) is among the top ten worldwide causes of cancer related morbidity and mortality. Squamous cell carcinoma (SCC) accounts for over 90% of all cases in sub-Saharan Africa [1]. Azygos arch and azygos vein tumor thrombus in esophageal squamous cell carcinoma (ESCC) is a rarely reported phenomenon. We report a case of tumor thrombus in the azygos vein and arch in a patient with esophageal squamous cell carcinoma. To date only a single case of such tumor thrombus in the arch of the azygos vein have been reported which was subsequently managed with neoadjuvant chemotherapy followed by radical resection [2].