Findings
- Multiple areas of thrombus in the nondominant left transverse sinus with occlusive thrombus extending from the transverse-sigmoid sinus junction into the left internal jugular vein
- Lack of opacification of the bilateral cavernous sinuses
- Nonopacified, engorged left superior ophthalmic vein
- Nonocclusive filling defect in the right jugular bulb
- Lobulated anterior communicating artery aneurysm involving both A1 and A2 segments
- Partial opacification of left mastoid air cells
- Likely dilated perivascular space in the right basal ganglia
- Partial opacification of the left frontal, maxillary, and sphenoid sinuses as well as of multiple left ethmoid air cells with intermixed high attenuation material
- Prior left maxillary antrostomy
Diagnosis
Dural venous and cavernous sinus thrombosis
Sinusitis
Aneurysm
Sample Report
Head CT venogram:
Dural venous sinus thrombosis with multiple areas of thrombus in the nondominant left transverse sinus and occlusive thrombus extending from the transverse-sigmoid sinus junction into the left internal jugular vein. Lack of opacification of the bilateral cavernous sinuses is concerning for bilateral cavernous sinus thrombosis. There is also thrombosis of the left superior ophthalmic vein and nonocclusive thrombus in the right jugular bulb.
No acute hemorrhage or mass effect.
Lobulated anterior communicating artery aneurysm involving both A1 and A2 segments measuring 5 x 8 mm.
Findings concerning for sinusitis involving the left frontal, maxillary, and sphenoid sinuses as well as multiple left ethmoid air cells. Intermixed high attenuation material could represent blood products, inspissated secretions, or chronic fungal colonization. Prior left maxillary antrostomy.
Partial opacification of left mastoid air cells. Recommend correlation with clinical signs of mastoiditis.
Discussion