0:00

For another example of an intracranial

0:02

complication of perinasal sinus infection.

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I'm gonna show a patient who has a pretty rip roaring

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sphenoid sinusitis, and a somewhat complicated MRI scan.

0:14

So here's the patient, which

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you see on the T1-weighted scan,

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there's maxillary sinus opacification,

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there's ethmoid sinus opacification,

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there's sphenoid sinus opacification.

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In fact, there's a pterygoid air cell

0:28

here, which is opacified as well.

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There's slight hyperintensity to the secretions

0:33

here, which may be either due to protein

0:36

content or potentially you might have

0:39

fungal infection.

0:40

When we get to the sphenoid sinus,

0:43

we see somewhat irregularity to the luminal

0:47

diameter of both of the cavernous carotid

0:50

arteries. On post-gadolinium-enhanced scan,

0:53

I just wanna point out, this is the lumen of

0:56

the carotid artery, and you notice that there

0:58

is this low signal intensity area, which is

1:02

seen within the enhancing right cavernous sinus.

1:06

On the left side, there's some additional

1:09

areas of decreased contrast enhancement.

1:13

Normally, the cavernous sinus

1:14

enhances relatively homogeneously.

1:18

In this case, we have infection and purulent material

1:21

in the cavernous sinus bilaterally, and there

1:24

is partial thrombosis of this cavernous sinus.

1:27

We are not seeing the normal

1:29

uniform enhancement of the cavernous sinus,

1:33

and we're seeing this thickening of the

1:35

meninges of the cavernous sinus bilaterally.

1:38

Here again, we have another area here where

1:41

partial thrombosis of the cavernous sinus is

1:44

present, in this case, lateral to the carotid

1:47

artery—again, lateral to the carotid artery.

1:49

These all should be enhancing

1:51

uniformly. This is not a patient who has

1:55

aggressive, invasive fungal sinusitis.

1:57

This is a bacterial infection with associated

2:01

partial thrombosis of both cavernous sinuses,

2:05

associated with the sphenoid and ethmoid

2:08

disease, predominantly on the left side.

2:11

Let's just take a quick look at

2:12

this on the T2-weighted imaging.

2:15

And you can see the lower signal intensity

2:18

of the secretions on the T2-weighted scan.

2:21

Again, this may be due to hyperproteinaceous

2:23

secretions, or it could be a patient

2:27

where we might consider a fungal sinusitis,

2:31

with that brighter signal on T1

2:33

and darker signal on T2.

2:36

In fact, this was a bacterial, not fungal infection.

2:40

Again, another demonstration of the post-gadolinium

2:44

enhanced scan and the unusual appearance to the

2:47

cavernous sinus, with areas of purulent material

2:50

within the cavernous sinus and partial thrombosis.