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1/2021
vol. 86 Neuroradiology
abstract:
Original paper
Acute cerebral venous thrombosis – still underdiagnosed pathology in the emergency computed tomography of the brain
Jagoda Jacków-Nowicka
1
,
Jacek Jagiełło
1
,
Edyta Dziadkowiak
2
,
Joanna Bladowska
1
,
Marek Sąsiadek
1
,
Anna Zimny
1
1.
Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
2.
Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
Pol J Radiol 2021; 86: e574-e582
Online publish date: 2021/10/08
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Introduction
Acute cerebral venous thrombosis (CVT) is a rare condition that can lead to a serious clinical state; thus, prompt diagnosis and treatment are mandatory. Head computed tomography (CT) plays a crucial role in the initial prompt diagnosis in the emergency setting. The aim of the study was to retrospectively analyse emergency head CT studies and the rate of incorrect diagnoses and main sources of pitfalls. Material and methods Retrospective analysis of 31 emergency CT studies (22 without contrast, 19F/12M, age range: 4-94 years) of patients with confirmed acute CVT. Results Thrombosed dural sinuses were found in 24/31 (77.4%) cases, thrombosed veins in 7/31 (22.6%) cases, no lesions within vessels in 2/31 (6.5%) cases. Haemorrhagic brain lesions were found in 9/31 (29%) cases, hypodense oedema in 6/31 (19.6%) cases, brain swelling in 1/31 (3.2%) cases, and no parenchymal lesions were revealed in 15/31 (48.4%) cases. Correct diagnosis of CVT was established in 15 cases (48.4%); however, it was incorrect in 16 cases (51.6%). Incorrect cases consist of 4 groups: 1 – with both vascular and parenchymal lesions that were overlooked (50%), 2 – with vascular lesions only, which were either overlooked, misinterpreted, or covered by artefacts (31.3%,), 3 – with parenchymal lesions only, which were misinterpreted (12.5%), and 4 – with no lesions present in the emergency head CT (6.2%). Conclusions The high rate of incorrect diagnoses of acute CVT based on emergency head CT requires constant training of radiologists and their close cooperation with clinicians because a delayed diagnosis may be lethal to the patient. keywords:
cerebral venous thrombosis, brain CT, pitfalls |