Superior ophthalmic vein thrombus

Case contributed by Dr Wajeeha Zagham

Presentation

71 year old female from home alone presents with fever, sinusitis, presyncopal episode, and vomiting / diarrhoea.

Patient Data

Age: 71
Gender: Female

Contrast enhanced MRI confirms presence of thrombus and asymmetric enlargement of the right superior opthalmic vein. No definite filling defect demonstrated in the right cavernous sinus with symmetric bilateral opacification.

The left superior orbital vein is patent. No inflammation of the orbits. The dural venous sinuses are patent.

Opacification of the right spehnoid sinus. There is no appreciable intracranial extension or surrounding inflammatory change.

There is also mild mucosal thickening of the maxillary, left sphenoid sinuses.

There is no acute intracranial haemorrhage, acute large vessel infarct or focal intracranial mass lesion.

Summary:

1. Thrombus in the right superior orbital vein. No definite extension into the cavernous sinuses on MRI.

2. Appearance of the material in the right sphenoid sinus is atypical for mucus or proteinaceous fluid, findings may related to chronic sinusitis, but fungal sinusitis should be considered in the appropriate clinical setting.

Case Discussion

This 71 year old female presented feeling generally unwell. Her symptoms included right sided sinusitis - headaches/pressure which she stated felt like previous sinus headaches. She also reported right sided nasal blockage and purulent nasal discharge (brown/green/blood stained). Neurological examination was grossly normal and she reported no visual disturbance.

She developed sepsis and her admission was complicated by NSTEMI and APO. Treatment with antibiotics, dual antiplatelets and ACE inhibitors, beta blocker and diuretics.

The diagnosis was right sphenoid sinusitis (possibly fungal and bacterial) with S. aureus bacteraemia (likely source for superior ophthalmic vein thrombus).

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Case information

rID: 45961
Case created: 15th Jun 2016
Last edited: 2nd Jul 2016
System: Head & Neck
Tag: orbit
Inclusion in quiz mode: Included

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