Traumatic dural venous sinus gas predicts a higher likelihood of dural venous sinus thrombosis following blunt head trauma

The aim of this study was to assess the association between intrasinus gas and dural venous sinus thrombosis ( DVST ) in patients with blunt head trauma. Methods One hundred and two consecutive patients with blunt head trauma imaged with non‐enhanced CT and CT head venography at our institution between 1 July 2011 and 30 June 2016 were included. Image review was performed by two independent reviewers to assess for the presence of intrasinus or perisinus gas and DVST . Skull fractures involving a dural venous sinus, sinus hyperdensity, extraaxial haematoma, and/or extrinsic dural venous sinus compression were also recorded. Univariate and multivariate analyses estimated the associations between the imaging variables and DVST . Results Thirty‐seven cases of DVST were confirmed with CT venography: 10 (27.0%) occlusive, and 27 (73.0%) non‐occlusive. We detected 24 cases of intrasinus gas, all occurring with skull fractures. Gas localized to the sinus involved by the fracture in 23 (95.8%) of 24 cases. Additional gas within a contiguous sinus was present in nine (37.5%) cases. The association between intrasinus gas and DVST of the respective sinus was statistically significant ( OR : 11.3, CI : 3.9–32.9, P  < 0.0001). DVST was also significantly associated with the presence of a skull fracture ( P  = 0.04), fractures involving the sigmoid sinus ( P  = 0.0001), and sinus hyperdensity ( P  < 0.0001). Conclusion Traumatic intrasinus gas is associated with DVST in patients with blunt head trauma. Its detection on non‐enhanced CT examinations in the emergency care setting infers a higher risk of DVST and should prompt consideration of CT venography.