Gallium scintigraphy in a case of septic cavernous sinus thrombosis

Clinical Nuclear Medicine
C J PalestroA H Richman

Abstract

Septic cavernous sinus thrombosis, a relatively uncommon disease entity, frequently can be fatal. Early diagnosis is imperative in order that appropriate treatment be instituted. A 59-year-old woman who was admitted to our institution with complaints of diplopia, blurred vision and fevers that developed following a tooth extraction is presented. Initial CT and lumbar puncture on the day of admission were totally normal. A repeat CT performed 48 hours after admission, on the same day as gallium imaging, demonstrated findings consistent with cavernous sinus thrombosis. Gallium imaging demonstrated intense uptake in the left cavernous sinus and left orbit as well as moderately increased activity in the right cavernous sinus and orbit, confirming infection. The patient was treated with antibiotics, and repeat CT and gallium imaging were performed ten days later, both of which demonstrated near total resolution of the disease process. Conceivably, if gallium imaging had been initiated on the day of admission it may have been the first study to demonstrate an infectious process in the cavernous sinus. Gallium imaging should be considered as a diagnostic tool in the noninvasive workup of this entity.

Citations

Mar 29, 2001·Pediatric Neurology·A VisudtibhanS Chiemchanya
Mar 6, 2016·Journal of the Neurological Sciences·Ismail A Khatri, Mohammad Wasay
Feb 14, 2012·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Valmont Desa, Ryan Green
Jun 1, 1994·International Journal of Pediatric Otorhinolaryngology·D AssefaH Michalski
Oct 2, 2015·The Neurohospitalist·João Lemos, Eric Eggenberger

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