Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

• Published in: Pediatric radiology 2016-01, Vol.46 (1), p.67-72
• Main Authors: Singh, Sumit, Ramakrishnaiah, Raghu H., Hegde, Shilpa V., Glasier, Charles M.
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; Diagnosis, Differential; False Positive Reactions; Female; Hematoma, Epidural, Cranial - complications; Hematoma, Epidural, Cranial - diagnosis; Humans; Imaging; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - diagnosis; Magnetic Resonance Angiography - methods; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Phlebography - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Sinus Thrombosis, Intracranial - diagnosis; Sinus Thrombosis, Intracranial - etiology; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-015-3458-x

Background Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. Objective To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. Materials and methods We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. Results In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Conclusion Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.