Magnetic resonance imaging in chronic cavernous sinus thrombosis

Magnetic resonance (MR) imaging was performed in a female patient with a chronic septic form of cavernous sinus thrombosis. She developed diplopia, headache, and high fever one month after paranasal sinus surgery. Magnetic resonance imaging (MRI) revealed an isointense lesion in the right cavernous sinus with a decreased caliber of intracavernous internal carotid artery on T1-weighted coronary and axial plane. After gadolinium injection, the lesion was well enhanced on T1-weighted image. On T2-weighted image, the lesion appeared as a heterogenous hypointense mass in the cavernous sinus. Her symptoms and signs subsided after intensive antibiotic treatment for more than one month. Follow-up MRI showed a decreased size of the thrombus in the right cavernous sinus. MRI provides a precise understanding of normal anatomy and demonstrates details of the complex structures in the cavernous sinus. It is also a very good tool to study the flow character of blood and cerebral spinal fluid. In cavernous sinus thrombosis, MRI provides important diagnostic information concerning the flow status in the cavernous sinus and the involutional process of both thrombus formation and its disintegration.