Sinusitis with Cavernous Sinus and Other Intracranial Complications
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.
CA0139-Sinusitis with Cavernous Sinus and Other Intracranial Complications
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CA0139-Sinusitis with Cavernous Sinus and Other Intracranial Complications
Case ReportHistory
Exam
Prior Study
Findings
Nasal Cavity and Nasolacrimal Drainage System
There is mucoperiosteal thickening in the nasal cavity; this is mainly in the posterior middle meatus and sphenoethmoidal recess.
Sinuses
There is mucoperiosteal thickening in the involving the posterior ethmoid but mainly the sphenoid sinus bilaterally.
There is bone erosion along the posterior walls the sphenoid sinus with direct extension of the inflamed sinus mucosa and secretions into the cavernous sinus on both sides posteriorly and laterally; this particular finding is seen on series 4.
Orbits & Eyes
There is mild extraconal and intraconal edema within the orbit and possibly minimal swelling of the extraocular muscles. There is no orbital abscess.
The superior ophthalmic veins are markedly dilated and thrombosed and on the right side those changes are so extensive that they mimic and intraorbital abscess.
There is proptosis with some stretching of the optic nerves but no testing of the posterior aspect of the globes. There is minimal edema in the Tenon space.
Signs of early tension orbit are present bilaterally.
Nasopharynx
There is no deeply infiltrating or necrotic/ulcerative process of the nasopharynx.
Intracranial
There is a loculated most likely subdural abscess along the boney inferior lateral wall of the middle cranial fossa without extension along the falx.
There is bilateral cavernous sinus caused by direct extension of sphenoid sinus pathology into the cavernous sinus venous plexes.
This is best evaluated on series 4 were there is clearly evidence of bilateral cavernous sinus thrombosis as well as thrombosis of the right sphenoparietal sinus. Spread of abscess across the clival plexus is also present but does not extend to the lower clivus.
There is possible evidence of inflammation of the distal cavernous internal carotid artery but there is no infectious aneurysm present. There is also evidence of probable arteritis of the proximal right middle cerebral artery.
There is brain edema, cerebritis and abscess involving the distribution of the proximal lenticulostriate vessels on the right with a brain abscess in the posterior inferior frontal lobe.
Developmental Variants
N/A
Impression
Orbital complications include bilateral ophthalmic vein thrombosis and early tension orbit.
