26-year-old woman cigarette smoker otherwise healthy. Presented with one week of neck swelling. Little pain. History of frequent pharyngitis with last episode about 1 week ago. Treated with course of azithromycin.

What is most striking is the left internal jugular clot and pronounced adenopathy. Note the cavitary apical lung mass on the left. A dedicated Chest CT showed numerous other nodules.

Microbiology demonstrated Fusobacterium necrophorum and was treated with a course of antibiotics. She did well with a complete recovery.