title: Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings.
abstract: BACKGROUND
  Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus.
  
  
  OBJECTIVE
  To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall.
  
  
  METHODS
  We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner.
  
  
  RESULTS
  In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views.
  
  
  CONCLUSIONS
  Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.
authors.affiliation: Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA. sumitsingh78@yahoo.com.
authors.forename: Sumit
authors.initials: S
authors.lastname: Singh
authors.affiliation: Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
authors.forename: Raghu H
authors.initials: RH
authors.lastname: Ramakrishnaiah
authors.affiliation: Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
authors.forename: Shilpa V
authors.initials: SV
authors.lastname: Hegde
authors.affiliation: Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Glasier
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D010690:Phlebography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Children; Computed tomographic venography; Dural sinus thrombosis; Magnetic resonance venography; Posterior fossa and epidural hematoma; Pseudothrombosis of dural sinuses; Skull fracture