Sigmoid sinus thrombosis

Case contributed by Dr Varun Babu

Presentation

Metastatic carcinoma breast with severe suboccipital headache

Patient Data

Age: 60 years
Gender: Female
MRI

Thrombosed left sigmoid sinus and internal jugular vein. A 3.4 x 2.5 x 1.8 cm (TR x AP x CC) enhancing lytic expansile soft tissue lesion is seen involving left occipital condyle with anterolateral cortical break and perivertebral soft tissue component.

Moderate mucosal thickening with air fluid levels seen in bilateral maxillary, ethmoidal and right sphenoidal air cells.

Conclusion

  • left occipital condyle lytic expansile neoplasm causing left sigmoid and jugular venous thrombosis

  • no brain scondaries

  • moderate bilateral maxillary, ethmoidal and right sphenoidal sinusitis

 

Case Discussion

Always look for dural venous sinuses when relatively normal brain is seen in a patient with severe headache. The high signal intensity in pulse sequences alerted me first. The diffusion restriction raised the suspicion of intra-luminal thrombus. I went ahead and did a venogram to identify the absence of filling. Reviewing axial T1 weighted image enabled me to pick up the obvious asymmetry in the skull base which is one of the hidden areas of a brain study. I alerted the MR technician to do a i.v. gadolinium contrast study and a contrast enhanced venogram to reaffirm the findings. 

The malignant left occipital condyle lytic neoplasm has resulted in the venous thrombosis. The sluggish flow in the hypoplastic left transverse sinus is responsible for the high signal intensity in all pulse sequences. 

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Case information

rID: 61855
Published: 21st Jul 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Vivid Diagnostic Centre

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