PMC5542080_01
Computed tomography images of (a) initial presentation showing an occluded left internal jugular vein, (b) lung on presentation, (c) CT lung on day 3 and (d) abscess (see arrows) posterior of C1 on day 14.
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After endotracheal intubation, a computed tomography (CT) scan showed a retropharyngeal phlegmon as well as obstructive thrombi both in the entire left internal jugular vein and in parts of the right internal jugular vein (Figure 1). CT imaging (on ECLS) was performed to identify presumed infectious collections. CT findings showed an abscess formation posterior to cervical vertebra one (Figure 1), signs of osteomyelitis involving the body of C1 and the dens of C2, and an opacified left mastoid.
(a) Computed tomography lung post ECLS decannulation, (b) abscess on the right base of the cerebellar hemisphere on day 20, (c) epidural lesions (most likely blood) on day 20 and (d) follow-up CT at day 45.
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ICU discharge showed markedly improved lung fields, improvement of cavitations, resolution of fluid collections around C1 and C2, but persistence of thrombi in the jugular veins and part of the venous sinuses (see Figure 2). Intravenous flucloxacillin and intravenous followed by oral Bactrim were continued for eight weeks with oral flucloxacillin planned to continue for a further four months.