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AIR IN THE CAVERNOUS SINUS – ALWAYS ALARMING?

  • Venkatraman Indiran
    Correspondence
    Reprint Address: Venkatraman Indiran, MD, DNB, Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamil Nadu 600044, India.
    Affiliations
    Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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      A 26-year-old man who was undergoing treatment for diarrhea and vomiting for 3 days was referred for computed tomography (CT) of the brain, as he complained of headache. There was no history of visual disturbances, giddiness, or seizures. There was no craniospinal trauma. CT showed small focus of air (CT value ∼ −600 Hounsfield units) in the left cavernous sinus (Figure 1). The Radiology resident was alarmed on seeing the finding of cavernous sinus air. Sinister causes of gas in venous sinus include septic thrombophlebitis of the cavernous sinus, central skull base fracture, barotrauma, and penetrating craniocerebral trauma (
      • Rubinstein D
      • Symonds D.
      Gas in the cavernous sinus.
      ). Acute isolated sphenoid sinusitis has also been associated with air in cavernous sinus (
      • Matsuo S
      • Matsumoto K.
      Free air in the cavernous sinus secondary to acute isolated sphenoid sinusitis.
      ).
      Figure 1
      Figure 1Computed tomography scan of the (A) brain axial section and (B) coronal reformat shows a focus of air in the left cavernous sinus.

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