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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.70 no.1 São Paulo Jan. 2012 



"Black turbinate sign": a potential predictor of mucormycosis in cavernous sinus thrombophlebitis


"Sinal da concha preta": um potencial preditor de mucormicose nas tromboflebites do seio cavernoso



Douglas Mendes NunesI; Antônio José da RochaII; Marcos Rosa JúniorI; Carlos Jorge da SilvaII

IFellow in Neuroradiology, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil
IISection of Neuroradiology, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil




Rhinosinusitis has the potential to result in catastrophic intracranial extension in the presence of predisposing conditions, such as diabetes, immunosuppression (fungus) or the incomplete treatment of bacterial infection. It is assumed that cavernous sinus thrombophlebitis (CST) is secondary to retrograde extension due to a valveless system of the vein that communicates paranasal cavities to the cavernous sinus1. The "black turbinate sign" results from dry gangrene in affected tissues, which presents in early stages paranasal mucormycosis. Conversely, bacterial sinusitis does not promote local necrosis and, therefore, it affects neither mucosal enhancement nor its T2 signal intensity2.

A poor prognosis of CST highlights the relevance of correct diagnosis for early treatment. The "black turbinate sign" could represent a potential discriminating feature to distinguish mucormycosis in CST etiology (Figure).



1. Hoxworth JM, Glastonbury CM. Orbital and intracranial complications of acute sinusitis. Neuroimaging Clin North America 2010;20:511-526.         [ Links ]

2. Safder S, Carpenter JS, Roberts TD, Bailey N. The "black turbinate" sign: an early MR imaging finding of nasal mucormycosis. AJNR. Amer J Neuroradiol 2010;31:771-774.         [ Links ]



Antônio José da Rocha
Rua Cincinato Braga 232
01333-910 São Paulo SP - Brasil

Conflict of interest:
There is no conflict to interest to declare.

Received 24 August 2011
Received in final form 15 September 2011
Accepted 23 September 2011

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