Lemierre's syndrome caused by Streptococcus pyogenes in an elderly woman.

Lemierre's syndrome is characterized by septic thrombophlebitis of the internal jugular vein. It typically presents in healthy adolescents or young adults, usually preceded by an oropharyngeal infection, with the most common offending pathogen being Fusobacterium necrophorum. We present a case of Lemierre's syndrome in an elderly woman without antecedent oropharyngeal infection, caused by Streptococcus pyogenes. She was successfully treated with combined surgical and medical management.

Simultaneous unilateral anterior thoracoscopy with transcervical thyroidectomy for the resection of large mediastinal thyroid goiter.

BACKGROUND: Almost 25% of thyroid goiters have an intrathoracic component. Although the majority of mediastinal goiters may be approached through a cervical approach, up to a third of substernal goiters require a sternotomy or thoracotomy for resection. As an alternative to conventional sternotomy, we herein describe a combined anterior thoracoscopic and transcervical approach to large mediastinal thyroid goiters. METHODS: Between 2012 and 2015, seven patients with symptomatic thyroid goiters with significant intrathoracic extension were approached via simultaneous cervical exploration and anterior thoracoscopy. Thoracoscopy was performed on the side of maximal goiter extension. RESULTS: Simultaneous thoracoscopy and transcervical thyroidectomy was technically successful in all patients. No patients required conversion to open approach and one patient required reoperation for hemorrhage. CONCLUSIONS: Simultaneous anterior thoracoscopy and cervical exploration is a safe and effective approach to large mediastinal thyroid goiter. Patients with significant intrathoracic goiter extension may benefit from preoperative thoracic surgical evaluation and planned thoracoscopy at the time of thyroidectomy.