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This was a seven-month-old child who presented

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with otomastoiditis on the right side.

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If we look at the brain images,

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we see that the patient has somewhat

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large vessels for age.

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And as we continue down inferiorly,

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we see the inflammation that is present superficial

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to the upper portion of the mastoid region.

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Here in the mastoid region,

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basically, we see bilateral opacification on T

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two-weight scan of the mastoid air cells.

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And on the right side,

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you also see the external auditory canal,

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which is opacified.

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On the post-contrast-enhanced scan,

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you get a sense that the patient has meningeal

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enhancement in the posterior fossa,

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which is rather striking.

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And where one would expect to see the sigmoid

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sinus and distal transverse sinus,

1:03

instead, we see enhancing tissue.

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Here's the flow void on the left side,

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which is normal. On the right side,

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you have this opacification with

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enhancing matted tissue.

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And even as we go down into the

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sigmoid sinus region here,

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here's the normal sigmoid sinus

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leading into the jugular vein.

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I want to point this out on the

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right side with my magic pen.

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What you're seeing is enhancement in the wall of

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the sigmoid sinus going into the jugular vein.

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But within the jugular vein,

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we're seeing low signal intensity tissue

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and the sigmoid sinus as well.

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And this represents the thrombus which is going from

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sigmoid sinus into the jugular vein at the

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skull base. If we continue to scroll down,

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we can see the jugular vein absence of a flow void.

1:58

Here's the normal jugular vein

1:59

and internal carotid artery.

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Here's the internal carotid artery

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and the jugular vein.

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And there is enhancing tissue within the carotid

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sheath on the right side associated

2:12

with the thrombosed vessel.

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So this is thrombophlebitis of the right internal

2:20

jugular vein secondary to mastoiditis.

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Let me just point out anatomically the structures

2:28

that we sometimes will refer to in the carotid

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sheath, and that is the overlying musculature.

2:36

So this darker signal intensity superficial to

2:39

the carotid artery is the Styloid musculature,

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which defines the post-thyroid parapharyngeal space,

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the carotid space from the pre-styloid parapharyngeal

2:50

space, which has the fat within it,

2:53

and this is part of this tissue here.

2:59

the styloglossus, the stylopharyngeus, and

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the stylohyoid muscles.

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Let's just quickly look at the sagittal image

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because it will nicely demonstrate

3:12

the inflamed jugular vein.

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This is the normal sigmoid sinus and jugular

3:19

vein on the left side.

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On the right side,

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you have all of this thickened tissue from the

3:26

mastoiditis and you have the clot within the

3:31

sigmoid sinus going into the jugular vein below.