A case of Lemierre-like syndrome with mediastinal–pulmonary communication managed without lung resection

Lemierre-like syndrome, an atypical variant of Lemierre's syndrome, is characterised by septic thrombophlebitis without classical features and may be complicated by descending necrotising mediastinitis (DNM). Contrast-enhanced computed tomography revealed extensive thrombosis of the right internal jugular, external jugular, and subclavian veins, along with multiple cervical and mediastinal abscesses, consistent with DNM. A cystic lesion in the right upper lobe suggested a lung abscess. Emergency cervical drainage was performed, followed by thoracoscopic mediastinal drainage. Communication between the mediastinal and pulmonary abscess cavities was identified intraoperatively. As no air leak was detected during a 20 cmH₂O leak test, pulmonary resection was avoided. Methicillin-susceptible Staphylococcus aureus was isolated, and the patient recovered with antibiotics and anticoagulants. The patient remained recurrence-free for 7 months. Careful intraoperative assessment may allow successful management without resection in selected cases of mediastinal-pulmonary communication.