Cavernous sinus thrombosis CT scan: Difference between revisions

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==Overview==
==Overview==
[[CT scan|High-resolution contrast-enhanced CT scan]] is useful in the assessment of cases with clinical features of cavernous sinus thrombosis. In early stages of the disease the CT and MRI findings may be normal. Findings on CT scan suggestive of cavernous sinus thrombosis include: Irregular filling defects within the [[cavernous sinus]], thickening of the [[superior ophthalmic vein]], poor enhancement of the [[cavernous sinus]], hypodensity in the region of the [[cavernous sinus]], thickening and dilation of the [[superior ophthalmic vein]], opacification of the [[paranasal sinuses]] and [[ethmoidal air cells]].


==CT scan==
==CT scan==
* [[CT scan|High-resolution contrast-enhanced CT scan]] is useful in the assessment of cases with clinical features of cavernous sinus thrombosis.<ref name="pmid23497466" />


* In early stages of the disease the CT and MRI findings may be normal.<ref name="pmid23497466">{{cite journal| author=Komatsu H, Matsumoto F, Kasai M, Kurano K, Sasaki D, Ikeda K| title=Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report. | journal=Head Face Med | year= 2013 | volume= 9 | issue=  | pages= 9 | pmid=23497466 | doi=10.1186/1746-160X-9-9 | pmc=3605125 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497466  }} </ref>


On noncontrast CT, thrombosis of the cavernous sinus can be appreciated as increased density. The introduction of intravenous contrast can reveal filling defects within the cavernous sinus as well as thickening of the superior ophthalmic vein. Nevertheless, CT scan findings may be subtle, and a negative CT scan cannot rule out CST reliably when the clinical suspicion is high.
* Findings on CT scan suggestive of cavernous sinus thrombosis include:<ref name="pmid23497466" /><ref name="pmid16946393">{{cite journal| author=Absoud M, Hikmet F, Dey P, Joffe M, Thambapillai E| title=Bilateral cavernous sinus thrombosis complicating sinusitis. | journal=J R Soc Med | year= 2006 | volume= 99 | issue= 9 | pages= 474-6 | pmid=16946393 | doi=10.1258/jrsm.99.9.474 | pmc=1557894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16946393  }} </ref>
 
**Irregular filling defects within the [[cavernous sinus]]
 
**Thickening of the [[superior ophthalmic vein]]
 
**Poor enhancement of the [[cavernous sinus]]
The post contrast computerized tomography (CT) scan on the left shows poor enhancement of the cavernous sinus bilaterally. The uncontrasted CT scan on the right shows subtle hypodensity in the region of the cavernous sinus. There is also associated opacification of the sphenoid sinus and posteriorly situated ethmoidal air cells. <ref name="pmid16946393">{{cite journal| author=Absoud M, Hikmet F, Dey P, Joffe M, Thambapillai E| title=Bilateral cavernous sinus thrombosis complicating sinusitis. | journal=J R Soc Med | year= 2006 | volume= 99 | issue= 9 | pages= 474-6 | pmid=16946393 | doi=10.1258/jrsm.99.9.474 | pmc=1557894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16946393  }} </ref>
**Hypodensity in the region of the [[cavernous sinus]]
 
**Thickening and dilation of the [[superior ophthalmic vein]]
 
**Primary source of infection:
 
***Opacification of the [[paranasal sinuses]]
The diagnosis of CST is best established on clinical grounds and confirmed by appropriate radiographic studies. High-resolution contrast-enhanced CT or MRI is useful in the assessment of cases with clinical features of cavernous sinus thrombosis. Contrast-enhanced CT scan may reveal the primary source of infection, thickening of the superior ophthalmic vein, and irregular filling defects in the cavernous sinus.
***Opacification of the [[ethmoidal air cells]]
Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment.
Contrast enhanced CT of the orbits showed right proptosis and fat stranding in the left orbit. The left superior ophthalmic vein was enlarged, suggesting thrombosis. Contrast enhancement was noted within left cavernous sinuses and dilation of the cavernous sinus, indicative of inflammation of the cavernous sinus. Paranasal sinuses were clear on the left side. In contrast, the maxillary, ethmoid and sphenoid sinuses on right side showed mucosal thickening and retention of purulent material. The right sphenoid sinus was predominant and occupied the area underneath the cavernous sinus. Magnetic resonance imaging (MRI) confirmed the CT findings. Post-contrast T1 images showed enlargement of the left cavernous sinus with some defects, representing thrombosis of the left cavernous sinus. Coronal CT showed the right sphenoid sinus was dominant and much larger than the left
Coronal CT showed the right sphenoid sinus was dominant and much larger than the left.
The CT and MRI findings may be normal, especially early in the disease course.<ref name="pmid23497466">{{cite journal| author=Komatsu H, Matsumoto F, Kasai M, Kurano K, Sasaki D, Ikeda K| title=Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report. | journal=Head Face Med | year= 2013 | volume= 9 | issue=  | pages= 9 | pmid=23497466 | doi=10.1186/1746-160X-9-9 | pmc=3605125 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497466  }} </ref>
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include:
*[Finding 1]
*[Finding 2]
*[Finding 3]
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include:
*[Complication 1]
*[Complication 2]
*[Complication 3]


==References==
==References==

Revision as of 15:52, 9 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

High-resolution contrast-enhanced CT scan is useful in the assessment of cases with clinical features of cavernous sinus thrombosis. In early stages of the disease the CT and MRI findings may be normal. Findings on CT scan suggestive of cavernous sinus thrombosis include: Irregular filling defects within the cavernous sinus, thickening of the superior ophthalmic vein, poor enhancement of the cavernous sinus, hypodensity in the region of the cavernous sinus, thickening and dilation of the superior ophthalmic vein, opacification of the paranasal sinuses and ethmoidal air cells.

CT scan

  • In early stages of the disease the CT and MRI findings may be normal.[1]

References

  1. ↑ 1.0 1.1 1.2 Komatsu H, Matsumoto F, Kasai M, Kurano K, Sasaki D, Ikeda K (2013). "Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report". Head Face Med. 9: 9. doi:10.1186/1746-160X-9-9. PMC 3605125. PMID 23497466.
  2. ↑ Absoud M, Hikmet F, Dey P, Joffe M, Thambapillai E (2006). "Bilateral cavernous sinus thrombosis complicating sinusitis". J R Soc Med. 99 (9): 474–6. doi:10.1258/jrsm.99.9.474. PMC 1557894. PMID 16946393.

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