EURORAD ESR

Case 15251

Cerebral venous thrombosis in a young female patient with nephroblastoma

Author(s)
Ana Coutinho Santos1, Alexandra Borges2

1Radiology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
2Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
 
Patient
female, 23 year(s)
 
 
  • Figure 1
    Young female patient with IV-stage nephroblastoma with pleuropulmonary metastatic disease
     

    A. Axial enhanced CT demonstrating a heterogeneous and hypodense mass of the right kidney with invasion and thrombosis of the right renal vein and inferior vena cava.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    B. Chest radiograph depicting several oval and well-defined pleural-based opacities on the right side and a ipsilateral hilar mass with no silhouette sign with the right heart border.

     
    Area of Interest: Thoracic wall; Thorax; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Non-enhanced CT of the brain after a first seizure episode

    Axial non-enhanced CT image shows a left posterior temporal hypodensity-causing mass effect (long arrow) with no midline displacement and a spontaneous hyperdensity in the ipsilateral transverse sinus (dashed arrows).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia; Seizure disorders;
     
     
  • Figure 3
    Contrast-enhanced CT of the brain after a first seizure episode
     

    A. At contrast-enhanced CT, the lesion does not enhance (short white arrow) and cerebral arteries are patent (white arrowheads).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    B. At contrast-enhanced CT, there is absent enhancement of the left jugular bulb (short black arrow) and normal enhancement on the right side (long black arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 4
    Axial T1W, T2W and coronal FLAIR MR images
     

    A. Lesion in the left posterior cortico-subcortical temporo-occipital region with hypointensity on T1W images (white arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    B. Lesion in the left posterior cortico-subcortical temporo-occipital region with hyperintensity on T2W images (black arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    C. Lesion in the left posterior cortico-subcortical temporo-occipital region with hyperintensity on FLAIR images (short arrow) consistent with brain oedema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 5
    Diffusion-weighted MR images
     

    A. b=1000 s/mm2. High signal on DWI (arrows, A) and low signal on ADC images (dashed arrows, B) in the cortex consistent with restricted diffusion, suggesting the presence of cytotoxic oedema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    B. ADC map. High signal on DWI (arrows, A) and low signal on ADC images (dashed arrows, B) in the cortex consistent with restricted diffusion, suggesting the presence of cytotoxic oedema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 6
    T1W MR images before and after intravenous gadolinium administration
     

    A. There is spontaneous hyperintensity in the left sigmoid sinus and ipsilateral jugular bulb (white arrows) indicating loss of normal flow void and raising suspicion of subacute dural venous sinus thrombosis.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    B. Post-contrast image confirms absence of flow in the transverse sinus (black arrows) and the hypointense lesion is suggestive of cerebral infarction in the corresponding territory (short white arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 7
    MR venography
     

    A. T1-weighted post-gadolinium three-dimensional sagittal image depicting lack of flow in left transverse (white arrow) which confirmed the suspicion of left dural venous sinus thrombosis.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;

    B. Coronal time-of-flight MR-venography depicting lack of flow in left sigmoid sinus and ipsilateral jugular bulb (dashed arrows) which confirmed the suspicion of left dural venous sinus thrombosis.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Ischaemia / Infarction;
     
     
A. Axial enhanced CT demonstrating a heterogeneous and hypodense mass of the right kidney with invasion and thrombosis of the right renal vein and inferior vena cava.
 
B. Chest radiograph depicting several oval and well-defined pleural-based opacities on the right side and a ipsilateral hilar mass with no silhouette sign with the right heart border.
 
Axial non-enhanced CT image shows a left posterior temporal hypodensity-causing mass effect (long arrow) with no midline displacement and a spontaneous hyperdensity in the ipsilateral transverse sinus (dashed arrows).
 
A. At contrast-enhanced CT, the lesion does not enhance (short white arrow) and cerebral arteries are patent (white arrowheads).
 
B. At contrast-enhanced CT, there is absent enhancement of the left jugular bulb (short black arrow) and normal enhancement on the right side (long black arrow).
 
A. Lesion in the left posterior cortico-subcortical temporo-occipital region with hypointensity on T1W images (white arrow).
 
B. Lesion in the left posterior cortico-subcortical temporo-occipital region with hyperintensity on T2W images (black arrow).
 
C. Lesion in the left posterior cortico-subcortical temporo-occipital region with hyperintensity on FLAIR images (short arrow) consistent with brain oedema.
 
A. b=1000 s/mm2. High signal on DWI (arrows, A) and low signal on ADC images (dashed arrows, B) in the cortex consistent with restricted diffusion, suggesting the presence of cytotoxic oedema.
 
B. ADC map. High signal on DWI (arrows, A) and low signal on ADC images (dashed arrows, B) in the cortex consistent with restricted diffusion, suggesting the presence of cytotoxic oedema.
 
A. There is spontaneous hyperintensity in the left sigmoid sinus and ipsilateral jugular bulb (white arrows) indicating loss of normal flow void and raising suspicion of subacute dural venous sinus thrombosis.
 
B. Post-contrast image confirms absence of flow in the transverse sinus (black arrows) and the hypointense lesion is suggestive of cerebral infarction in the corresponding territory (short white arrow).
 
A. T1-weighted post-gadolinium three-dimensional sagittal image depicting lack of flow in left transverse (white arrow) which confirmed the suspicion of left dural venous sinus thrombosis.
 
B. Coronal time-of-flight MR-venography depicting lack of flow in left sigmoid sinus and ipsilateral jugular bulb (dashed arrows) which confirmed the suspicion of left dural venous sinus thrombosis.
 
 
 
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