Sinusitis with Intracranial and Vascular 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.
CA0142-Sinusitis with Intracranial and Vascular Complications
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CA0142-Sinusitis with Intracranial and Vascular Complications
Case ReportHistory
Exam
Prior Study
Findings
Nasal Cavity and Nasolacrimal Drainage System
There is mucoperiosteal thickening in the nasal cavity mainly on the right.
Sinuses
There is mucoperiosteal thickening in the right frontal, maxillary and ethmoid sinuses. There is no air fluid level in the frontal sinus and no soft tissue swelling anterior to the frontal sinus or in the soft tissues surrounding the maxillary sinuses.
There is no bone erosion or findings of a pre-existing mucocele.
Orbits & Eyes
There is a preseptal, periorbital, subperiosteal abscess along the right superior lateral orbital rim without evidence of significant intraconal or extraconal soft tissue swelling, or direct continuity with the sinus disease. The superior and inferior ophthalmic veins are not dilated or thrombosed. There is no evidence of any ocular complication or tension orbit.
Intracranial
There is a loculated epidural and possibly partial subdural abscess along the right frontal bone inner table. An epidural abscess spreads to the right side of the falx and then across it to the left. There is no bone erosion. There is no further spread within the dura of the falx.
There is evidence of thrombosis or thrombophlebitis manifest as abnormality somehow reaching the sigmoid sinus without obvious contiguous spread and from there spreading along veins to the epidural plexus at the cranial cervical junction and then to the venous system in the deep neck more on the right than the left producing extensive swelling in the paravertebral musculature much worse on the right than the left.
There is extensive and multifocal brain micro abscesses involving the right frontal lobe.
Other findings:
There is very extensive spread of this intracranial disease to the epidural space at the craniocervical junction and by way of veins into the deep soft tissues of the neck bilaterally producing marked enhancement of the paravertebral muscles bilaterally but more on the right than left.
Impression
A highly unusual pattern of abnormality in this patient shows not obviously contiguous thrombophlebitic spread of disease to the sigmoid sinus and then communicating with the venous drainage system through the jugular fossa as well as other veins to involve veins in the deep neck as well as the epidural space at the craniocervical junction.
There is a subperiosteal preseptal orbital cellulitis along the orbital roof on the right side that does not communicate with the sinuses.
