CSF rhinorrhea - CT cisternography

Case contributed by Dr Dalia Ibrahim

Presentation

History of prior surgery, now abnormal watery fluid leaking from her nose. Her physician suspects CSF rhinorrhea.

Patient Data

Age: 40 years
Gender: Female

Bone defect is seen in the right cribriform plate. 

Contrast leak and accumulation within the right maxillary antrum, anterior ethmoid air cells and nasal cavity. 

Annotated image

Bone defect is seen in the right cribriform plate. (Red arrow)

Contrast leak and accumulation within the right maxillary antrum, anterior ethmoid air cells and nasal cavity. (Yellow arrows)

Case Discussion

CT cisternography is diagnostic modality for diagnosing occult site of CSF leak, it is performed after injecting contrast into thecal sac, and the patient is placed in a Trendelenburg position to opacify the basal cisterns, followed by CT imaging (thin-section coronal and axial CT images in both prone and supine positions) immediately after administration of contrast material.

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