Contrast-enhanced MRI confirms the presence of thrombus and asymmetric enlargement of the right superior ophthalmic vein. No definite filling defect demonstrated in the right cavernous sinus with symmetric bilateral opacification.
The left superior ophthalmic vein is patent. No inflammation of the orbits. The dural venous sinuses are patent.
Opacification of the right sphenoid 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 be related to chronic sinusitis, but fungal sinusitis should be considered in the appropriate clinical setting.