Presentation
Postoperative imaging of right posterior fossa acoustic schwannoma. Asymptomatic.
Patient Data
Translabyrinthine approach craniotomy and resection of the right acoustic neuroma noted with expected postoperative changes, including a small amount of pneumocephalus. Grey-white matter differentiation is preserved. Ventricles and basal cisterns are normal. No midline shift or cerebral herniation.
Dense right internal jugular vein highly suspicious for thrombosis; right sigmoid and transverse sinuses are unremarkable for a noncontrast study.
Conclusion: Features suggestive of right internal jugular vein thrombosis.
Comparison made to CT brain from earlier the same day. There is a filling defect in the right internal jugular vein extending from the jugular bulb 2cm inferiorly. This is consistent with thrombus. No extension above the jugular foramen. The right sigmoid and transverse sinuses opacify normally. No other filling defect identified. Right trans labyrinthine craniotomy with fat packing. Pneumocephalus has resolved. No intracranial hemorrhage. Grey-white matter differentiation is preserved. Ventricular size is unchanged.
Courtesy of Dr Heather Pascoe
Case Discussion
This case illustrates a post-operative internal jugular vein thrombosis on the first day after excision of a right acoustic neuroma.