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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.11 São Paulo Nov. 2014

http://dx.doi.org/10.1590/0004-282X20140143 

Images in Neurology

Dural sinus thrombosis with the empty delta sign

Trombose de seio dural com o sinal do delta vazio

Diogo Goulart Corrêa1  2 

Geraldo Veloso Correia1 

Rafael Silveira Borges1  2 

1Hospital Casa de Portugal, Rio de Janeiro RJ, Brazil

2Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil


A 43-year-old woman, presented with headache, reduced visual acuity, for 5 days and bilateral papilledema. Non-enhanced cerebral computed tomography (CT) was normal. The venous angiography-CT revealed the empty delta sign within superior sagittal, right transverse and sigmoid sinuses, characterizing sinus thrombosis (Figure). The empty delta sign is a central intraluminal filling defect, representing a thrombus surrounded by contrast-enhanced dural collateral venous channels1. It can be seen in 25%-75% of sinus thrombosis, using wider window settings than those used for brain parenchyma2. Most often, non-contrast CT is normal, hence the importance of using intravenous contrast when suspecting of dural thrombosis3.

Figure Contrast-enhanced computed tomography (A and B) shows intraluminal filling defects in sagittal sinus (white arrow in A) and transverse right sinus (black arrow in B), surrounded by contrast (the empty delta sign), characterizing right transverse and superior sagittal sinuses thrombosis. Compare the right with the left transverse sinuses, in B, to see the intraluminal filling defect. Non-enhanced computed tomography was normal (not shown). Magnetic resonance venous angiography (C) of the same patient shows a filling defect affecting almost the entire superior sagittal sinus (thin white arrows in C). 

References

. Provenzale JM, Kranz PG. Dural sinus thrombosis: sources of error in image interpretation. AJR Am J Roentgenol. 2011;196(1):23-31. http://dx.doi.org/10.2214/AJR.10.5323 [ Links ]

. Rodallec MH, Krainik A, Feydy A, Hélias A, Colombani JM, Jullès MC et al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics. 2006;26 Suppl 1:S5-18. http://dx.doi.org/10.1148/rg.26sj065505 [ Links ]

. Wasay M, Azeemuddin M. Neuroimaging of cerebral venous thrombosis. J Neuroimaging. 2005;15(2):118-28. http://dx.doi.org/10.1111/j.1552-6569.2005.tb00296.x [ Links ]

Received: May 08, 2014; Revised: July 25, 2014; Accepted: August 14, 2014

Correspondence: Diogo Goulart Corrêa; Rua Duquesa de Bragança, 85 / ap. 109; 20540-300 Rio de Janeiro RJ, Brasil; E-mail: diegogoulartcorrea@yahoo.com.br

Support: Hospital Casa de Portugal

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

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.