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CSF LEAK

Scism JTS - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: CSF LEAK

History: - This patient is a 47 year old female who presented to the ENT service complaining of clear left rhinorrhea. She had no other complaints and denied any recent trauma or surgery.

Findings: - After a lumbar puncture and injection of Indium-111 DTPA (0.58mCi / 0.47 ml) the patent was immediately scanned to ensure the injection was intrathecal; this is seen as a vertical column of tracer activity seen in the forth image. A second series of images was obtained at 4 hrs (top remaining 5 images)which showed normal flow of the radiotracer through the spinal column and around the convexities as expected, with an abnormal collection of radiotracer seen anterior and inferior to the expected location CFS. A third series of images (bottom 5 images) was obtained at 24 hrs which again showed radiotracer had accumulated in the expected areas of the anterior nasal sinuses and meatus bilaterally.

Dxhow: Pledget counts and visualized radiotracer leak.

Exam: Phyical exam showed: Clear rhinorhea, bilaterally Lab values of interest: positive Beta-2 microglobulin = 2.20 MG/L (normal 0-1.85) (This is a marker for CSF in nasal, aural or other discharge). Prior to the intrathecal injection of Indium-111 DTPA, the patient had three pledgets placed by the ENT service in her superior meatus, middle meatus, and inferior meatus bilaterally. The pledgets showed absorption of radiotracer bilaterally. Higher counts were seen on the left with the left superior meatus showing the single greatest area of activity with a net pledge 10 minute-count number of 40,264. The patient’s net plasma count was 2734. The net counts per gm / net counts 1 of ml plasma = 49.0 for the superior left meatus, 35.2 for the middle left meatus, 33.3 for the inferior left meatus, 8.5 for the superior right meatus, 5.4 for the middle right meatus, and 4.9 for the inferior right meatus. The normal ratio was calculated at = 1.3.

No MeSH data available.


This vertex view at 24 hours shows a high number of radiotracer counts that has leaked out of the CSF space into the anterior nasal airways.  A faint line of radiotracer is seen tracking from the anterior CSF space to the left side of the nasal airway radiotracer collection; this likely represents the area of the greatest amount of the CSF leak.
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MPX1668_synpic19821: This vertex view at 24 hours shows a high number of radiotracer counts that has leaked out of the CSF space into the anterior nasal airways. A faint line of radiotracer is seen tracking from the anterior CSF space to the left side of the nasal airway radiotracer collection; this likely represents the area of the greatest amount of the CSF leak.


CSF LEAK

Scism JTS - MedPix

This vertex view at 24 hours shows a high number of radiotracer counts that has leaked out of the CSF space into the anterior nasal airways.  A faint line of radiotracer is seen tracking from the anterior CSF space to the left side of the nasal airway radiotracer collection; this likely represents the area of the greatest amount of the CSF leak.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1668&req=5

MPX1668_synpic19821: This vertex view at 24 hours shows a high number of radiotracer counts that has leaked out of the CSF space into the anterior nasal airways. A faint line of radiotracer is seen tracking from the anterior CSF space to the left side of the nasal airway radiotracer collection; this likely represents the area of the greatest amount of the CSF leak.

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: CSF LEAK

History: - This patient is a 47 year old female who presented to the ENT service complaining of clear left rhinorrhea. She had no other complaints and denied any recent trauma or surgery.

Findings: - After a lumbar puncture and injection of Indium-111 DTPA (0.58mCi / 0.47 ml) the patent was immediately scanned to ensure the injection was intrathecal; this is seen as a vertical column of tracer activity seen in the forth image. A second series of images was obtained at 4 hrs (top remaining 5 images)which showed normal flow of the radiotracer through the spinal column and around the convexities as expected, with an abnormal collection of radiotracer seen anterior and inferior to the expected location CFS. A third series of images (bottom 5 images) was obtained at 24 hrs which again showed radiotracer had accumulated in the expected areas of the anterior nasal sinuses and meatus bilaterally.

Dxhow: Pledget counts and visualized radiotracer leak.

Exam: Phyical exam showed: Clear rhinorhea, bilaterally Lab values of interest: positive Beta-2 microglobulin = 2.20 MG/L (normal 0-1.85) (This is a marker for CSF in nasal, aural or other discharge). Prior to the intrathecal injection of Indium-111 DTPA, the patient had three pledgets placed by the ENT service in her superior meatus, middle meatus, and inferior meatus bilaterally. The pledgets showed absorption of radiotracer bilaterally. Higher counts were seen on the left with the left superior meatus showing the single greatest area of activity with a net pledge 10 minute-count number of 40,264. The patient’s net plasma count was 2734. The net counts per gm / net counts 1 of ml plasma = 49.0 for the superior left meatus, 35.2 for the middle left meatus, 33.3 for the inferior left meatus, 8.5 for the superior right meatus, 5.4 for the middle right meatus, and 4.9 for the inferior right meatus. The normal ratio was calculated at = 1.3.

No MeSH data available.