Case 9 - Transverse Sinus Injury

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EXAM: CTA HEAD W/WO IV CONTRAST

INDICATION: Status post trauma. Seizure, right parietal pilocytic astrocytoma and likely alcohol abuse who presented after a fall from a flight of stairs. Imaging showed 1.2cm extra-axial hematoma extending from the right posterior fossa to the occipital lobes with associated depressed skull fracture extending from the occipital bone to the foramen magnum.

TECHNIQUE: CT venogram of the head was performed, utilizing 65 mL Omnipaque 350 intravenous contrast. Coronal and sagittal reformatted images and 3D maximum intensity projection images were generated.

COMPARISON: CT head the same day at 6:24 PM.

FINDINGS:

Mass effect from the acute displaced occipital/suboccipital fractures and associated extra-axial hemorrhage on the right transverse sinus, which is nonopacified, possibly thrombosed. The right sigmoid sinus and jugular bulb are patent and there is prominent collateral venous flow along the right tentorial leaflet and right middle cerebral vein. Mass effect from extra-axial hemorrhage extending across the midline partially effaces the posterior superior sagittal sinus and venous confluence, also the proximal aspect of the left transverse sinus which is narrowed. The remainder of the superior sagittal sinus and central venous structures including the internal cerebral veins, vein of Galen, and straight sinus are patent. There is homogeneous symmetric enhancement of the cavernous sinus.

Configuration of skull fractures and size and mass effect of extra-axial hemorrhage has not substantially changed from prior exam, again measuring up to 1.2 cm in the right posterior fossa. Similar scattered pneumocephalus throughout the site of hematoma. Postoperative changes of right parietal craniotomy and mass resection with encephalomalacia in the right parietal lobe, as before. Please refer to prior CT head for additional findings.

IMPRESSION:

The right transverse sinus is not opacified, effaced by the right occipital/suboccipital extra-axial hemorrhage, and possibly thrombosed. The right sigmoid sinus is widely patent and there is evidence of collateral venous flow. Mass effect partially effaces the posterior superior sagittal sinus, venous confluence, and proximal left transverse sinus. The remaining dural venous sinuses are patent.

The presence of the blood products posterior to the superior sagittal sinus as well as crossing from the posterior fossa to the supratentorial space suggests epidural blood collection which has increased in size overall compared with the study from 6:25 PM in the supratentorial compartment. There likely is a fracture associated with the craniotomy of the right parietal bone as there is air seen on series 5 image 94 outside and deep to the craniotomy site.

Introduction

Introduction to Emergency Head, Neck & Spine Imaging

Clinical Scenario 1 (Updated)

Orbital Trauma/Inflammation

Clinical Scenario 2

Facial/Neck Trauma

Clinical Scenario 3

Sore Throat Pain and Fever

Clinical Scenario 4

Mass in the Neck

Clinical Scenario 5

Cervical Spine Trauma

Clinical Scenario 6

Fever, Back Pain

Clinical Scenario 7

Head & Neck Emergencies

Case 9 - Transverse Sinus Injury