J Korean Soc Radiol.  2015 Jun;72(6):418-422. 10.3348/jksr.2015.72.6.418.

Fulminant Superior Ophthalmic Vein and Cavernous Sinus Thrombophlebitis with Intracranial Extensions: Case Reports

• Hwang J
• Hong HS
• Park J
• Lee A
• Choo EJ
• Chang KH

• KMID: 2098022
• DOI: http://doi.org/10.3348/jksr.2015.72.6.418

Abstract

Cavernous sinus thrombophlebitis (CST) is a rare and life-threatening disease without prompt diagnosis and treatment. Two cases of fulminant superior ophthalmic vein (SOV) and CST caused by maxillary periodontitis and sphenoid sinusitis are described. A 65-year-old woman presented with right proptosis, headache, and fever. A 74-year-old woman presented with left periorbital swelling. In both patients, MRI with gadolinium showed expansion of the bilateral cavernous sinus and diffuse dilatation of the SOV with non-enhancement of central thrombus, which indicated CST. The condition was complicated by brain abscess, meningitis, and ischemic stroke. These conditions were improved by antibiotic treatment, but one patient underwent exenteration of the orbit due to orbital rupture during hospitalization.

MeSH Terms

Aged
Brain Abscess
Cavernous Sinus
Cavernous Sinus Thrombosis*
Diagnosis
Dilatation
Exophthalmos
Female
Fever
Gadolinium
Headache
Hospitalization
Humans
Magnetic Resonance Imaging
Meningitis
Orbit
Paranasal Sinus Diseases
Periodontitis
Rupture
Sphenoid Sinus
Sphenoid Sinusitis
Stroke
Thrombophlebitis
Thrombosis
Veins*
Gadolinium

Figure

• 

  Fig. 1 A 65-year-old female presented with 2-week history of right-sided proptosis, headache, and fever. A. Axial contrast-enhanced three-dimensional fast spoiled gradient-echo (3D FSPGR) image reveals multifocal, irregular filling defects within an expanded, enhanced cavernous sinus. B. Axial contrast-enhanced 3D FSPGR image shows linear filling defect in dilated left superior ophthalmic vein (SOV). C. The thrombosed left SOV exhibits a high signal intensity on diffusion-weighted imaging. D. Axial contrast-enhanced T1-weighted spin echo images (repetition time/echo time, 600/9.3 msec) shows brain abscesses on the left anterior temporal convexity.

• 

  Fig. 2 A 74-year-old female presented with periorbital swelling and purulent discharge from left eye. A. Axial contrast-enhanced computed tomographic scan reveals left-sided proptosis, a gas-containing abscess in the left preseptal region. The left sphenoid sinus exhibits mucosal thickening. B. Axial contrast-enhanced T1-weighted fat-suppressed spin-echo image (repetition time/echo time, 816.6/9 msec) reveals a dilated, non-enhanced, left superior ophthalmic vein and rim-enhanced abscesses in the preseptal region and intraconal space. Thick enhancement of the dura along the left frontotemporal cerebral convexity is seen. C. Follow-up diffusion-weighted imaging after orbital exenteration reveals ischemic infarctions in the left basal ganglia and periventricular white matter.

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