Cavernous sinus thrombosis complicating sinusitis.
BACKGROUND
Septic cavernous sinus thrombosis is a rare complication of paranasal sinusitis.


OBJECTIVE
To familiarize the clinician with the pathogenesis, diagnosis, and appropriate management of septic cavernous sinus thrombosis.


METHODS
Case report and literature review.


METHODS
Pediatric intensive care unit in a university hospital.


METHODS
We present a 12-yr-old female with a 1 wk history of an upper respiratory tract infection with worsening dyspnea, cough, and swelling of the left eye progressing to adult respiratory distress syndrome. Secondary to the need for significant mechanical ventilatory support, venovenous extracorporeal membrane oxygenation was initiated. Computed tomography scan of the head and neck with contrast revealed bilateral cavernous sinus thrombosis. After broad-spectrum intravenous antibiotics and aggressive supportive care in conjunction with surgical intervention (maxillary sinus lavage and right orbital exploration) and anticoagulation therapy, the patient recovered. Blood cultures were positive for Viridans streptococcus. At discharge 3 wks later, the patient had improved, but had right-eye blindness.


CONCLUSIONS
The diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome.
Cannon
Michael L
ML
Department of Anesthesiology, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston-Salem, NC, USA.
Antonio
Benjamin L
BL
McCloskey
John J
JJ
Hines
Michael H
MH
Tobin
Joseph R
JR
Shetty
Avinash K
AK
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012852:Sinusitis / Q000150:complications*; D013290:Streptococcal Infections; D034363:Viridans Streptococci
D000900:Anti-Bacterial Agents