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Radiology Quiz Case 1—Diagnosis

Radiology Quiz Case 1—Diagnosis Diagnosis: Childhood cavernous sinus thrombophlebitis Cavernous sinus thrombosis (CST) is a rare childhood disease that is caused by bacterial infection. Acute paranasal sinusitis1-3 and acute mastoiditis4 are the most common predisposing factors. At the end of the 19th century, 2 pathogenic mechanisms were suggested to explain otogenic CST: direct spread of infection along pathways created by erosive osteitis and retrograde thrombophlebitis.4 The bacteria most frequently found were Streptococcus pneumoniae, Staphylococcus aureus, and gram-negative rods, as well as anaerobes.2,3 The most common symptoms of CST are fever, headache, chemosis, proptosis, exophthalmos, disturbed vision, and oculomotor nerve palsy.2-4 In the past, invasive radiologic techniques, such as orbital phlebography and intracranial arteriography, were performed to confirm the diagnosis of CST, but the findings were not always conclusive. Currently, noninvasive cross-sectional neuroimaging studies, such as CT and MRI, are the methods of choice in cases of suspected CST, because they allow direct visualization of the cavernous sinus. Enhanced-contrast CT and MRI scans reveal (1) abnormal enhancement with filling defects and an increased T2 signal corresponding to a thrombus, (2) enlargement of the cavernous sinus, and (3) enhancement of the dura mater along the lateral border of the cavernous sinus. A CT scan with bone windows can confirm the suspected location of the underlying infectious process and aid in the evaluation of the integrity of the temporal bone.5-8 The therapeutic management of CST consists of intravenous administration of appropriate antibiotics, with radical mastoidectomy if medical therapy alone should fail.3 Anticoagulant therapy is controversial.4 Levine et al9 found no conclusive evidence of reduced mortality when anticoagulants were used in combination with antibiotics. Anticoagulants were recommended only to reduce morbidity among survivors.9 Before antibiotics came into use, CST was almost invariably fatal.3,4,9 However, despite the aggressive treatment currently used, the outcome is not always favorable, and some cases of mortality,3 along with high morbidity rates,1,10 have been reported. References 1. Odabasi OAAkgul A Case report: cavernous sinus thrombosis: a rare complication of sinusitis. Int J Pediatr Otorhinolaryngol.1997;39:77-83.PubMedGoogle Scholar 2. Kriss TCKriss VMWarf BC Cavernous sinus thrombophlebitis: case report. Neurosurgery.1996;39:385-389.PubMedGoogle Scholar 3. Soga YOka KSato M et al Cavernous sinus thrombophlebitis caused by sphenoid sinusitis: report of autopsy case. Clin Neuropathol.2001;20:101-105.PubMedGoogle Scholar 4. Doyle KJJackler RK Otogenic cavernous sinus thrombosis. Otolaryngol Head Neck Surg.1991;104:873-877.PubMedGoogle Scholar 5. Snyder TCSachdev HS MR imaging of cerebral dural sinus thrombosis. J Comput Assist Tomogr.1986;10:889-891.PubMedGoogle Scholar 6. Holzmann DHuisman TLinder T Lateral dural sinus thrombosis in childhood. Laryngoscope.1999;109:645-651.PubMedGoogle Scholar 7. De Slegte RGMKaiser MCVan der Baan SSunt L Computed tomographic diagnosis of septic sinus thrombosis and their complications. Neuroradiology.1988;30:160-165.PubMedGoogle Scholar 8. Dessout BMeder JFBrugières P et al Diagnostic radiologique des lésions vasculaires de la loge caverneuse. Feuill Radiol.1999;39:118-133.Google Scholar 9. Levine SRTwyman REGilman S The role of anticoagulant in cavernous sinus thrombosis. Neurology.1988;38:517-522.PubMedGoogle Scholar 10. Ali SMAhmed SH Cavernous sinus thrombosis in children. J Trop Pediatr.1992;38:194-195.PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Radiology Quiz Case 1—Diagnosis

Archives of Otolaryngology - Head & Neck Surgery , Volume 130 (3) – Mar 1, 2004

Radiology Quiz Case 1—Diagnosis

Abstract

Diagnosis: Childhood cavernous sinus thrombophlebitis Cavernous sinus thrombosis (CST) is a rare childhood disease that is caused by bacterial infection. Acute paranasal sinusitis1-3 and acute mastoiditis4 are the most common predisposing factors. At the end of the 19th century, 2 pathogenic mechanisms were suggested to explain otogenic CST: direct spread of infection along pathways created by erosive osteitis and retrograde thrombophlebitis.4 The bacteria most frequently found were...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.130.3.374-a
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Childhood cavernous sinus thrombophlebitis Cavernous sinus thrombosis (CST) is a rare childhood disease that is caused by bacterial infection. Acute paranasal sinusitis1-3 and acute mastoiditis4 are the most common predisposing factors. At the end of the 19th century, 2 pathogenic mechanisms were suggested to explain otogenic CST: direct spread of infection along pathways created by erosive osteitis and retrograde thrombophlebitis.4 The bacteria most frequently found were Streptococcus pneumoniae, Staphylococcus aureus, and gram-negative rods, as well as anaerobes.2,3 The most common symptoms of CST are fever, headache, chemosis, proptosis, exophthalmos, disturbed vision, and oculomotor nerve palsy.2-4 In the past, invasive radiologic techniques, such as orbital phlebography and intracranial arteriography, were performed to confirm the diagnosis of CST, but the findings were not always conclusive. Currently, noninvasive cross-sectional neuroimaging studies, such as CT and MRI, are the methods of choice in cases of suspected CST, because they allow direct visualization of the cavernous sinus. Enhanced-contrast CT and MRI scans reveal (1) abnormal enhancement with filling defects and an increased T2 signal corresponding to a thrombus, (2) enlargement of the cavernous sinus, and (3) enhancement of the dura mater along the lateral border of the cavernous sinus. A CT scan with bone windows can confirm the suspected location of the underlying infectious process and aid in the evaluation of the integrity of the temporal bone.5-8 The therapeutic management of CST consists of intravenous administration of appropriate antibiotics, with radical mastoidectomy if medical therapy alone should fail.3 Anticoagulant therapy is controversial.4 Levine et al9 found no conclusive evidence of reduced mortality when anticoagulants were used in combination with antibiotics. Anticoagulants were recommended only to reduce morbidity among survivors.9 Before antibiotics came into use, CST was almost invariably fatal.3,4,9 However, despite the aggressive treatment currently used, the outcome is not always favorable, and some cases of mortality,3 along with high morbidity rates,1,10 have been reported. References 1. Odabasi OAAkgul A Case report: cavernous sinus thrombosis: a rare complication of sinusitis. Int J Pediatr Otorhinolaryngol.1997;39:77-83.PubMedGoogle Scholar 2. Kriss TCKriss VMWarf BC Cavernous sinus thrombophlebitis: case report. Neurosurgery.1996;39:385-389.PubMedGoogle Scholar 3. Soga YOka KSato M et al Cavernous sinus thrombophlebitis caused by sphenoid sinusitis: report of autopsy case. Clin Neuropathol.2001;20:101-105.PubMedGoogle Scholar 4. Doyle KJJackler RK Otogenic cavernous sinus thrombosis. Otolaryngol Head Neck Surg.1991;104:873-877.PubMedGoogle Scholar 5. Snyder TCSachdev HS MR imaging of cerebral dural sinus thrombosis. J Comput Assist Tomogr.1986;10:889-891.PubMedGoogle Scholar 6. Holzmann DHuisman TLinder T Lateral dural sinus thrombosis in childhood. Laryngoscope.1999;109:645-651.PubMedGoogle Scholar 7. De Slegte RGMKaiser MCVan der Baan SSunt L Computed tomographic diagnosis of septic sinus thrombosis and their complications. Neuroradiology.1988;30:160-165.PubMedGoogle Scholar 8. Dessout BMeder JFBrugières P et al Diagnostic radiologique des lésions vasculaires de la loge caverneuse. Feuill Radiol.1999;39:118-133.Google Scholar 9. Levine SRTwyman REGilman S The role of anticoagulant in cavernous sinus thrombosis. Neurology.1988;38:517-522.PubMedGoogle Scholar 10. Ali SMAhmed SH Cavernous sinus thrombosis in children. J Trop Pediatr.1992;38:194-195.PubMedGoogle Scholar

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Mar 1, 2004

Keywords: radiology specialty

References