title: A case of lateral sinus insufficiency with acute otitis media: Early surgical intervention for prevention of lateral sinus thrombosis.
abstract: OBJECTIVE
  To describe a case of lateral sinus insufficiency, presumably occurring just prior to lateral sinus thrombosis (LST), and to discuss the importance of early surgical intervention and the pathophysiology of full-blown LST.
  
  
  METHODS
  A 4-year-old boy developed headaches and vomiting after exhibiting typical symptoms of acute otitis media. Contrast-enhanced CT revealed narrowing of the sigmoid sinus medially by gas and low-density material. We diagnosed the patient with suspected LST and consequently performed mastoidectomy. A large amount of bloody pus was found in the mastoid cavity and below the bony sinus plate. Sigmoid sinus blood flow was completely restored after drainage of the hemorrhagic and purulent material, and the patient recovered fully.
  
  
  CONCLUSIONS
  Because of the anatomical features of the dural venous sinus, hemorrhage per diapedesis may be strongly associated with the development of LST. In the patient with suspected LST, early diagnosis and surgery prior to the development of intravenous thrombus are key for full recovery from this condition.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan. Electronic address: kuniyuki@med.niigata-u.ac.jp.
authors.forename: Kuniyuki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogi
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Ohshima
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
authors.forename: Sugata
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D061345:Early Medical Intervention; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008416:Mastoid / Q000601:surgery; D010033:Otitis Media / Q000150:complications; D054064:Transverse Sinuses / Q000601:surgery*; D014689:Venous Insufficiency / Q000209:etiology / Q000601:surgery*
keywords: Hemorrhage per diapedesis; Intravenous thrombosis; Lateral sinus thrombosis