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Traumatic thrombosis of posterior condylar vein with extension to internal jugular vein

Abstract No: EE-09 

Authors:

S.Ali Nabavizadeh MD,

Aaron Bress DO,

Bryan Pukenas MD

Neuroradiology DivisionDepartment of Radiology University of Pennsylvania

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Disclosure statement

• Neither the authors nor their immediate family members have a financial

relationship with a commercial organization that may have a direct or

indirect interest in the content.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Overview

• Purpose• Case Report• Imaging

Findings• Summary

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

PurposeThe posterior condylar canal is located posterior to the occipital condyle and transmits the posterior condylar vein which is one of the largest emissary veins in the retromastoid region.

The posterior condylar vein exits the skull through the posterior condylar canal, which is a communication between the jugular foramen and the condylar fossa, situated just posterior to the occipital condyles on either side of the foramen magnum.

This canal allows for venous anastomosis between the jugular bulb and the suboccipital venous plexus

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Purpose

We report a patient with an occipital bone fracture coursing through the posterior condylar canal causing thrombosis of posterior condylar vein with extension to internal jugular vein.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Case report

• A 50 year old patient was brought to the

emergency department following a fall from 15

steps.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Imaging findings

Initial head CT scan demonstrated a linear occipital bone

fractures extending to the posterior condylar vein on the right

side. There was no extension of fracture line to the major dural

venous sinuses.

Subsequent CT venography demonstrated thrombosis of right

posterior condylar vein with extension to upper aspect of right

internal jugular vein causing non-occlusive thrombosis.

Patient was managed conservatively with no evidence of

hemorrhagic infarction or clot extension on follow-up imaging.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn RadiologyC

Axial CT scan demonstrates linear occipital bone fracture with extension to the right posterior condylar canal (A, arrow). Axial and sagittal oblique CTV (B and C) demonstrate right condylar vein thrombosis (arrow) with extension to right internal jugular vein (D, arrow).

A B

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Summary

The role of traumatic close head injuries as an important etiology of cerebral venous sinus thrombosis has been demonstrated in multiple studies.

In these studies, the criteria for performing CTV was extension of skull fracture line to the major dural venous sinuses including superior sagittal sinus, transverse sinus, sigmoid sinus, or jugular bulb.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Summary

To the best of our knowledge traumatic thrombosis of posterior condylar vein with subsequent extension to major venous sinuses has not been reported yet in English literature.

Increase awareness of radiologists to this anatomical structure and routine CT venograms for concerning skull fractures is important for appropriate diagnosis.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

References

1. Ginsberg LE. The posterior condylar canal. AJNR. 1994 May;15(5):969-72.

2. Delgado Almandoz JE, Kelly HR, Schaefer PW, et al. Prevalence of traumatic dural venous sinus thrombosis in high-risk acute blunt head trauma patients evaluated with multidetector CT venography. Radiology 2010; 255(2):570–577.

3. Rivkin MA, Saraiya PV, Woodrow SI. Sinovenous thrombosis associated with skull fracture in the setting of blunt head trauma. Acta Neurochir (Wien). 2014 May;156(5):999-1007.

Baltimore, Maryland

Perelman School of Medicine at University of Pennsylvania Penn Radiology

Thank You

seyedali.nabavizadeh@uphs.upenn.edu