Clinical question: Normal cavernous sinus pathology/posterior communicating artery aneurysm. Signs and symptoms: Right retro-orbital pain, head CT from outside hospital showed the right frontal hyperdense area. None infuse CT of brain:Examination demonstrates a small area of approximately 8mm times 8mm increased density within the cortex of right frontal lobe. This is not associated with any detectable edema or mass effect. The finding is believed to represent subtle calcification and likely a cavernoma. Further evaluation with a dedicated MRI examination is recommended.Examination the right no additional area of abnormal density, edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Images at the level of the cavernous sinuses demonstrate no pathology. Calvarium, limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. CTA of intracranial circulation:Carotid system.Supraclinoid internal carotids, bilateral anterior and middle cerebral arteries and their branches are visualized and no evidence of abnormality.There is no evidence of aneurysm of the posterior communicating arteries as clinically is questioned. Very small bilateral posterior communicating arteries can be detected only on MIP 2-D images and is not visualized on reformatted 3-D images.Vertebral basilar system:There is no evidence of aneurysm. Both intracranial vertebral arteries are visualized and unremarkable. Basilar artery is widely patent. Bilateral superior cerebellar arteries and posterior cerebral arteries are also unremarkable.Extensive motion artifact obscures some of the detail in both carotid systems and vertebral basilar system. The motion artifact causes significant irregularity and apparent narrowing of intracranial vertebral arteries bilaterally and irregularity of basilar artery.This examination demonstrates no detectable abnormality of cavernous sinuses as clinically is questioned. However note should be made that cavernous sinuses can be significantly better evaluated by an MRI examination read in the CTA. If clinical concern for cavernous sinus abnormality persist an MRI examination of brain is recommended which will also help for further evaluation of small calcific lesion in the right frontal lobe.
1.Small area of cortical increased density in the right frontal lobe is highly suspected of calcification of a small cavernoma. Follow-up with an MRI exam is recommended. Unremarkable CT of brain without contrast otherwise.2.Essentially unremarkable CTA of intracranial circulation.3.Motion artifact in particular through the images of posterior fossa creates significant irregularity and apparent stenosis of vertebral arteries.4.MRI examination is recommended for further evaluation of a small calcific lesion within the right frontal lobe (likely a cavernoma) as well as cavernous sinuses which cannot be properly Vater that on CTA.