A 17-year-old girl presented with headache, and right third and left sixth nerve palsies. MRI was performed. Coronal T1-W image after gadolinium administration (Fig. 1) demonstrated enlargement and pathological enhancement of the left cavernous sinus (arrow) with narrowing of the left internal carotid artery (arrowhead). Axial T2-W image (Fig. 2) showed opacification with high signal intensity in the ethmoid air cells. There was sphenoid sinus signal abnormality within an enlarged left cavernous sinus (arrow) involving a narrowed carotid artery (arrowhead).
Cavernous sinus thrombosis/thrombophlebitis (CST) is a rare, albeit potentially life-threatening, complication of paranasal sinusitis [1]. CST is most often associated with sphenoid or ethmoid disease and is spread through afferent and efferent venous extension via a network of valveless veins and also direct extension [2]. Signs and symptoms include fever, headache, ptosis, proptosis, chemosis, external ophthalmoplegia and decreased corneal reflex [1]. A high index of suspicion and emergent imaging are crucial to making an early and accurate diagnosis.
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Nguyen, CT.E., Faingold, R. Cavernous sinus thrombosis secondary to sinusitis: a rare and life-threatening complication. Pediatr Radiol 39, 633 (2009). https://doi.org/10.1007/s00247-008-1117-1
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DOI: https://doi.org/10.1007/s00247-008-1117-1