Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009:2009:bcr03.2009.1671.
doi: 10.1136/bcr.03.2009.1671. Epub 2009 Jul 26.

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Robin Gwynne Jones  1 , Brendan Arnold
Affiliations

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Robin Gwynne Jones et al. BMJ Case Rep. 2009.

Abstract

The present report concerns a patient who presented with a 4-day history of left-sided facial pain arising from a pre-existing dental infection and progressive shortness of breath. The patient had a previous diagnosis of rheumatoid arthritis and was being treated with methotrexate. The rapid development of a right eye proptosis necessitated urgent decompression with a lateral canthotomy and cantholysis. Imaging revealed a left facial abscess, cavernous sinus thrombosis (CST), bilateral internal jugular thrombosis and multiple lung abscesses. Blood cultures yielded Streptococcus constellatus, a member of the Peptostreptococcus family. The patient was admitted to the intensive care unit (ICU) with respiratory failure and septic shock. She was treated with intravenous meropenem and clindamycin, and anticoagulated. Despite early intervention, the patient developed a middle cerebral artery infarct. Over a 3-week period she was gradually weaned from vasopressor and ventilatory support.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Colour photograph showing proptosis of right eye.
Figure 2
Figure 2
Anteroposterior (AP) radiograph showing multiple bilateral circular opacities.
Figure 3
Figure 3
Post contrast venous phase CT scan of the head (axial view) showing an enlarged “S” shaped right superior ophthalmic vein with associated proptosis.
Figure 4
Figure 4
Sagittal CT scan of the head demonstrating an enlarged, tubular right superior ophthalmic vein.
Figure 5
Figure 5
Axial CT chest scan showing bilateral circular peripheral opacities.
Figure 6
Figure 6
Axial CT scan of the head showing left middle cerebral artery territory infarct.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryn Otol 2002; 116: 667–76 - PubMed
    1. Shaw RE. Cavernous sinus thrombophlebitis: a review. Br J Surg 1952; 40: 40–8 - PubMed
    1. Harbour RC, Trobe JD, Ballinger WE. Septic cavernous sinus thrombosis associated with gingivitis and parapharyngeal abscess. Arch Ophthalmol 1984; 102: 94–7 - PubMed
    1. Feldman DP, Picerno NA, Porubsky ES. Cavernous sinus thrombosis complicating odontogenic parapharyngeal space neck abscess: a case report and discussion. Otolaryngol Head Neck Surg 2000; 123: 744–5 - PubMed
    1. Mazzeo V. Cavernous sinus thrombosis. J Oral Med 1974; 29: 53–6 - PubMed

LinkOut - more resources