Neuro_CTA_Head/Neck: 66 M, history of seizure.
CT Angio Head and Neck, CT Head with and without Contrast
HISTORY: 66 years old Male with history of seizure.
FINDINGS:
NON CONTRAST HEAD:
Hyperdensity in the posterior left occipital lobe in the region of the transverse and sigmoid sinus concerning for venous sinus thrombosis. Hyperdense material in the sulcus in the left temporal lobe consistent with subarachnoid hemorrhage. Attenuation of the brain parenchyma is preserved. No mass effect or midline shift is identified. The ventricles are appropriate in size and relatively symmetric in configuration. Partially absent septum pellucidum. Paranasal sinuses and mastoid air cells are clear. No suspicious calvarial lesions are identified. Bony orbits and their contents are symmetric and intact.
ANGIOGRAM: No significant atherosclerotic disease is identified in the head or neck.
There is three vessel aortic arch anatomy. The origins of the great vessels are patent.
The cervical segments of the carotid arteries are normal in course and caliber. No stenosis is noted at the carotid bifurcations.
Petrous, cavernous, and supraclinoid segments of bilateral internal carotid arteries are patent and normal in course and caliber. The branches of bilateral middle cerebral and anterior cerebral arteries are patent. The ophthalmic arteries are identified.
Bilateral vertebral arteries arise from the subclavian arteries. Their patent cervical segments enter the foramen transversarium at normal mid cervical levels. The distal intracranial segments of the vertebral arteries are patent, with normal C1/C2 loops. The basilar
artery is patent and normal in caliber, giving rise to patent bilateral superior cerebellar arteries and posterior cerebral arteries.
Multiple prominent serpiginous vessels centered around the superior sagittal sinus in the region of the torcula but also in the left temporal and left occipital regions. There is prominence of the dural venous sinus system with prominent bilateral occipital extracranial arterial vessels. Overall, the findings are consistent with a high risk dural AV fistula.
POST CONTRAST HEAD: There are no areas of abnormal intracranial enhancement.
POST CONTRAST NECK: The remainder of the soft tissues of the neck appear unremarkable. Heterogeneity of the right upper lobe pulmonary vessels. Multilevel degenerative changes of the cervical spine are
appreciated. There are no other osseous lesions.
IMPRESSION:
1. Multiple prominent serpiginous vessels centered around the superior sagittal sinus in the region of the torcula, left temporal, and left occipital regions associated with dural venous sinus prominence and occipital extracranial arterial vessels. Overall, findings are consistent with a high-risk dural AV fistula.
2. Filling defect in the left transverse and sigmoid sinus corresponding with hyperdensity on noncontrast images, consistent with venous sinus thrombosis.
3. Subarachnoid hemorrhage along the left temporal lobe.
4. Heterogeneity of the right upper lobe pulmonary vasculature. This could be due to technique and this exam is not designed to evaluate for pulmonary embolus. If clinically concerned for pulmonary embolus, a dedicated chest CTA can be obtained.
Accession: CL27388557
Study description: CT ANG HEAD NCK
