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Case Reports
. 2013 Mar 13:9:9.
doi: 10.1186/1746-160X-9-9.

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

Hiroaki Komatsu  1 , Fumihiko Matsumoto, Misato Kasai, Kaori Kurano, Daisuke Sasaki, Katsuhisa Ikeda
Affiliations
Case Reports

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

Hiroaki Komatsu et al. Head Face Med. .

Abstract

Objective: To report a rare case of unilateral cavernous sinus thrombosis caused by contralateral sphenoid sinusitis.

Case report: A 33-year-old female visited our hospital for severe, right-sided, temporal headache, chemosis, periorbital edema, and proptosis. These signs were associated with congested erythematous nasal mucosa with purulent discharge from the right superior nasal meatus. Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment.

Conclusions: Sphenoiditis can cause contralateral cavernous sinus thrombosis. Early surgical sphenoidotomy and aggressive medical treatment are the cornerstones of successful management of this life-threatening complication.

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Figures

Figure 1
Figure 1
Left eye lid at initial presentation. At initial presentation, the left eye showed edema of the upper and lower lids as well as periorbital edema, chemosis and congestion of the conjunctiva.
Figure 2
Figure 2
Contrast-enhanced CT. Contrast-enhanced CT showed enhancement and dilation of left cavernous sinus (arrowhead). Sphenoid sinus occupied the low density area. The right sphenoid sinus extended posteriorly to the left sinus and was in contact with both cavernous sinuses (arrow).
Figure 3
Figure 3
Contrast-enhanced CT. CT shows dilation of the left superior ophthalmic vein (arrow).
Figure 4
Figure 4
Contrast-enhanced MRI. Contrast-enhanced T1 MRI showed enhancement of the left cavernous sinus with some defects.
Figure 5
Figure 5
Pre-operative coronal CT in bone window. Coronal CT showed the right sphenoid sinus was dominant and much larger than the left.
Figure 6
Figure 6
Post-operative coronal CT in bone window. In post-operative CT displayed the right sphenoid sinus was drained by operation.
See this image and copyright information in PMC

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