Axial unenhanced sinus CT image in soft tissue windows was p | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Axial unenhanced sinus CT image in soft tissue windows was performed in a young child with vague facial symptoms for possible sinusitis. What are the abnormal findings? What is the leading diagnostic consideration? Answers and another image will follow later today. Comment below with your thoughts! #FridayQuizDay

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Sagittal postcontrast CT image child with a closed head injury shows injury to the anterior portion of the superior sagittal sinus with extravasation of contrast (arrow) into the extracranial soft tissues and partial thrombus (arrowhead) of the anterior aspect of the superior sagittal sinus. The most common site of dural venous sinus injury is the anterior and middle third of the superior sagittal sinus. Because of the rich collateral venous drainage at this location, patients can be treated with sinus ligation. #NeuroWednesday](https://app.figure1.com/case-detail/27bc424c-dd76-4ebd-a923-0fd96a696b66)

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Axial (image 1) and coronal (image 2) T1-weighted postcontrast images performed during an MR venogram show a large arachnoid granulation (arrow) in the sigmoid sinus. On the T2-weighted image (image 3) the arachnoid granulation continues to have high signal intensity. Arachnoid granulations are most common in the transverse sinus. Large arachnoid granulations can be difficult to distinguish from dural sinus thrombosis. They typically have a smooth border and project into the venous sinus but do not obstruct it. On noncontrast CT, arachnoid granulations are typically not visible while a sinus venous thrombosis may be hyperdense.

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