• Michael L Cannon, Benjamin L Antonio, John J McCloskey, Michael H Hines, Joseph R Tobin, and Avinash K Shetty.
• Department of Anesthesiology, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston-Salem, NC, USA.
• Pediatr Crit Care Me. 2004 Jan 1; 5 (1): 86-8.

BackgroundSeptic cavernous sinus thrombosis is a rare complication of paranasal sinusitis.ObjectiveTo familiarize the clinician with the pathogenesis, diagnosis, and appropriate management of septic cavernous sinus thrombosis.DesignCase report and literature review.SettingPediatric intensive care unit in a university hospital.PatientWe present a 12-yr-old female with a 1 wk history of an upper respiratory tract infection with worsening dyspnea, cough, and swelling of the left eye progressing to adult respiratory distress syndrome. Secondary to the need for significant mechanical ventilatory support, venovenous extracorporeal membrane oxygenation was initiated. Computed tomography scan of the head and neck with contrast revealed bilateral cavernous sinus thrombosis. After broad-spectrum intravenous antibiotics and aggressive supportive care in conjunction with surgical intervention (maxillary sinus lavage and right orbital exploration) and anticoagulation therapy, the patient recovered. Blood cultures were positive for Viridans streptococcus. At discharge 3 wks later, the patient had improved, but had right-eye blindness.ConclusionsThe diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome.

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