Cone beam computed tomography-guided transpterygoidal aspiration of a carotid space abscess in Lemierre's syndrome

Lemierre's syndrome results from anaerobic bacterial thrombophlebitis of the cervical venous vasculature, occasionally complicated by deep neck space abscesses, sepsis, septic emboli, vascular occlusions, or mycotic aneurysms. Fastidious organisms, such as Fusobacterium necrophorum, may be slow to respond to intravenous antibiotic therapy, prompting a need for more aggressive source control. Concomitant vascular occlusions and mycotic aneurysms present difficult decisions regarding anticoagulation, and the anatomy involved implies important technical considerations for intervention. A case of Lemierre's syndrome complicated by a carotid space abscess and mycotic internal carotid artery pseudoaneurysm progressed despite intravenous antibiosis. Transpterygoidal aspiration using cone beam computed tomography guidance provided both technical and clinical success.