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Use of Magnetic Resonance Venography to diagnose Lateral sinus thrombosis - a rare complication of chronic suppurative otitis media
Poster Title: Use of Magnetic Resonance Venography to diagnose Lateral sinus thrombosis - a rare complication of chronic suppurative otitis media
Submitted on 15 Sep 2017
Author(s): Eghoihunu Ireo, Prashant Gupta and Ganapathy Dhanasekar
Affiliations: Northern Lincolnshire & Goole NHS Foundation Trust
This poster was presented at British Institute of Radiology Annual Congress
Poster Views: 1,037
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Poster Information
Abstract: Since the emergence of antibiotics, lateral sinus thrombosis (LST) is an infrequent complication of otitis media. LST may occur by thrombophlebitis or penetration of offending pathogens through the dura of middle and posterior cranial fossae.

We present a case of right-sided sigmoid and transverse venous sinus thrombosis, a rare complication of chronic suppurative otitis media, and discuss the patient’s neuroimaging, management and relevant literature to offer clinical recommendations.

Case: A 39-year-old woman presented with headache, neck pain, vomiting, fever and photophobia with a tender right mastoid on examination. Computerised Tomography, Magnetic Resonance Imaging and Venograghy of the head revealed complete opacification of the right mastoid air cells and middle ear, with absent flow void in the right transverse and sigmoid sinus, consistent with thrombosis. We will use the CT and MRV images as a teaching tool to highlight radiological features suggestive of LST.
After discussion with neurosurgery, she was started on anticoagulation. The patient was readmitted with right otalgia and otorrhea refractory to medical treatment, and ultimately underwent right mastoid exploration.

Today otogenic LST is scarcely reported in developed countries. Literature warns that the classic spiking fever and positive cultures are increasingly absent, due to prior use of antibiotics. LST may occur with other intracranial or extracranial complications of otitis media. Clinicians should approach any complication with vigilance of sepsis and otogenic brain abscess. Imaging and progress with medical therapy determines extent of surgery. The importance and timing of recanalisation has not been widely studied but would inform follow-up.
Summary: 39-year-old woman presented with headache, neck pain and photophobia and had right mastoid tenderness on examination. Magnetic Resonance Venography definitively diagnosed right-sided lateral sinus thrombosis secondary to chronic otitis media. She was managed with antibiotics, mastoidectomy and anticoagulation.References: [1] Au JK, Adam SI, Michaelides EM. Contemporary management of pediatric lateral sinus thrombosis: a twenty year review. American journal of otolaryngology. 2013 Apr 30;34(2):145-50.

[2] Christensen N, Wayman J, Spencer J. Lateral sinus thrombosis: a review of seven cases and proposal of a management algorithm. International journal of pediatric otorhinolaryngology. 2009 Apr 30;73(4):581-4.

[3] Goldenberg RA. Lateral sinus thrombosis: medical or surgical treatment?. Archives of Otolaryngology. 1985 Jan 1;111(1):56-8.

[4] Iseri M, Aydn Ö, Üstündag E, Keskin G, Almaç A. Management of lateral sinus thrombosis in chronic otitis media. Otology & Neurotology. 2006 Dec 1;27(8):1098-103.

[5] Lee JH, Choi SJ, Park K, Choung YH. Managements for lateral sinus thrombosis: does it need the ligation of internal jugular vein or anticoagulants?. European Archives of Oto-Rhino-Laryngology. 2009 Jan 1;266(1):51-8.

[6] Ropposch T, Nemetz U, Braun EM, Lackn
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