Normal CT head and CTV (teaching)

Case contributed by UoE Radiology

Presentation

Recently post-partum. Had headaches as teenager. Now severe headaches.

Patient Data

Age: 30
Gender: Female
Modality: CT

No intra- or extra-axial collection or haemorrhage demonstrated.  No focal abnormality.  Grey-white differentiation is preserved. Ventricular size, sulcal pattern and basal cisterns all appear normal. No bony abnormality demonstrated.

 

= normal CT head

CT venogram

Modality: CT

This again is a normal scan.  There are a few small hypodense areas in the contrast rich veins but these are not clots, instead the arachnoid granulations that "suck up" the excess CSF.

If there was a clot, we would see a big hypodense dark space in a sinus (or more than one) - and this would usually correspond with a hyperdense area in non-contrast CT.  With contrast, you can sometimes see collateral vessels in the areas which are clotting.

Case Discussion

This is a normal examination.

Radiologists do a remarkable number of scans which are normal (in spite of wildly unusual presentations or symptoms).  Part of the skill in radiology is knowing when something is normal, and also what else can or should be done to check again (in this case, CTV).

However even with a normal case, there are still a number of learning points that have been covered in this case.

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Thanks to Dr Frank Gaillard for this wonderfully normal case.  The original is available here.

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Case Information

rID: 34158
Case created: 6th Feb 2015
Last edited: 23rd Sep 2015
Inclusion in quiz mode: Included

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