Computed tomographic diagnosis of septic lateral sinus thrombosis

Fatal Septic Internal Jugular Vein-Sigmoid Sinus Thrombosis Associated with a Malpositioned Central Venous Catheter

Septic internal jugular vein-sigmoid sinus thrombosis (IJV-SST) associated with a malpositioned central venous catheter is a rare condition. It is potentially life-threatening and necessitates early diagnosis and rapid administration of appropriate medications. Unfortunately, it is difficult to diagnose due to vague clinical presentations. Several studies such as CT, MRI, and cerebral angiography should be performed and carefully examined to help make the diagnosis. We report a case of septic IJV-SST due to a malpositioned central venous catheter.

Internal jugular vein thrombosis in a case of attico antral disease - a rare presentation in this modern antibiotic era

We report a case of Internal Jugular Vein Thrombosis with a long segment thrombus in a clinical setting of attico antral type of Chronic Suppurative Otitis Media (CSOM) in a 20 year male. He presented with hectic rise of temperature with chills & rigor of 7 days duration associated with left ear discharge & throbbing headache of 10 days duration. ENT examination revealed attico antral type of Chronic suppurative Otitis Media with sinus thrombophlebitis. Further investigations revealed a mural thrombus extending from the lower part of Internal Jugular Vein (IJV) till the Torcula Herophili. Left Modified radical mastoidectomy with exposure of transverse & sigmoid sinus was done to completely eradicate the disease and source of infection. The patient was treated with oral anticoagulants and parenteral antibiotics based on the sensitivity report and became asymptomatic after 8 weeks.

Septic thrombosis of the transverse and sigmoid sinuses: imaging findings

The purpose of this study was to evaluate the contribution of magnetic resonance imaging (MRI) to the diagnosis of septic thrombosis of transverse and sigmoid sinuses to analyze the different steps of the diagnosis and to identify the origin of the difficulties in diagnosis. This retrospective study included eight patients aged 53-81 years (mean age: 61.9 years) with proven or highly probable septic thrombosis of transverse and sigmoid sinuses. All patients underwent a pre- and post-contrast enhancement brain CT scans and MRI. MR venogram (n=4) and HRCT of the temporal bone were performed when diagnosis was under discussion. After admission, the delay in diagnosis of lateral sinus thrombosis ranged from 8 to 60 days, with an average of 27 days (SD: +/-12.8). The delay in diagnosis was mainly due to non focused CT scans (6/8) or MR images performed at the initial presentation and absence of systematic radiological reading of the related fatty spaces and of skull base in bone windows (3/8). Diagnosis of septic origin of the thrombosis is of great importance, as it completely modifies the therapeutic planning of the patients. However, it remains a difficult challenge due to its lack of suggestive neurological or otolaryngologic symptoms.

Lateral sinus thrombosis complicating mastoiditis

Although otitis media is easily recognized in the emergency department, its complications can often be missed. We present the case of a patient with mastoiditis with lateral sinus thrombosis that was not diagnosed until a digital subtraction angiogram revealed the occlusion.

Central nervous system complications secondary to oto-rhinologic infections. An analysis of 39 pediatric cases

Fifty-eight central nervous system complications were noted in 39 pediatric patients with a primary oto-rhinological infection. The ages ranged from 1 to 15 years. Eleven patients (25%) had more than one complication. 12.8% of the cases died. Leptomeningitis was the most common intracranial complication (54%) Lateral sinus thrombosis (LST) occurring in 10 patients (26%) was accompanied with other intracranial abnormalities in 80% of cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (40%). In two of these fatal cases multiple brain abscesses were detected. The low incidence of intracranial infections secondary to oto-rhinologic infections and the masking effect of antibiotics present difficulties in the early recognition of the CNS complication. Despite the value of the modern imaging techniques in the investigation of the CNS complication, the clinical oto-rhinologic examination is of paramount importance in detecting the original infection in the pneumatic spaces of the upper respiratory tract. Additionally, bone scans were found of value in demonstrating the osteitic process of these cases.