Post contrast head CT
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0587-Post contrast head CT
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CA0587-Post contrast head CT
Case ReportExam
Prior Study
There is evidence of aggressive right otomastoiditis with sigmoid plate dehiscence (coalescent otomastoiditis) producing a small volume, epidural abscess, which partiall compresses the adjacent dural sinus.
Focal deformity of the sigmoid sinus is evident at the site of epidural abscess, however, the remaining lumen of the right sigmoid sinus and the internal jugular vein are patent.
Intraluminal thrombus is present in the torcular herophile, the left transverse/sigmoid sinuses, extending into the high cervical left IJ.
CT Perfusion
No CT perfusion was obtained
CTV of the Neck
Thrombosis of the high cervical left internal jugular vein with collateral drainage into the other left neck veins. The right IJ is patent. No soft tissue abnormality is evident within the cervical soft tissues. There was no head CTA with venous filling. A head MRV was performed 4 days later.
Findings
Post contrast head CT for venocapillary pool analysis
There is known thrombus within multple dural sinuses from prior imaging. The posterior SSS does demonstrates an empty delta sign indicating intraluminal thrombus. The right transverse sinus does not opacify indicating thrombosis. There is contrast enhancment in the region of the torcula and in part of the left transverse sinus; This enhancement is more consistent with opacification in their dural sinus walls; there is no luminal contrast in the distal left transverse or sigmoid sinuses to indicate luminal patency.
There is prominence of the lateral tentorial venous confluences on both sides and in the torcular tentorial venous confluence. This is secondary evidence of dural sinus CVT with re-routing of pial veins into the dural/pial anastomosing ultimately exiting through the meningeal venous system.
There is evidence of effacement of sulci plus ventriculomegaly consistent with early hydrocephalus. There is evidence of optic hydrops. Both findings provide evidence that the dural sinus thromboses have caused increase intracranial pressure on the basis of venous hypertension.
There is no evidence of focal reduced CT density within the venocapillary pool in any part of the brain to suggest potential venous parenchymal stroke. There is a small, left vertex, incidental arachnoid cyst.
Impression
2. There is no evidence of reduced CT density within the venocapillary pool in either the cerebrum or cerebellum.
3. There is evidence of both optic hydrops and early hydrocephalus related to venous hypertension caused by the dural sinus egress block. It is concievable that the hydrocephalus could be in part related to meningitis associated with the right coalsecent otomasoiditis.
