IMAGES IN EMERGENCY MEDICINE

Dan C. S. Im, MD; Amy H. Kaji, MD, PhD

0196-0644/$-see front matter
Copyright © 2022 by the American College of Emergency Physicians.
https://doi.org/10.1016/j.annemergmed.2022.05.034

Figure 1. Coronal computed tomography images of soft

tissues of the neck revealed a right internal jugular vein
thrombus (black arrow). Figure 3. Axial computed tomography of the chest revealed
multiple pulmonary septic emboli (black arrows).

[Ann Emerg Med. 2022;80:508.]

A 53-year-old woman with an unremarkable medical
history presented to the emergency department with 2
weeks of right-sided frontal headache and right-sided neck
pain and 3 days of fever, dizziness, nausea, vomiting, and
inability to ambulate. Her vital signs revealed a temperature
of 38 C (100.4 F). Physical examination revealed pain
with neck flexion, inability to ambulate without assistance,
and significant right-sided dysmetria on finger-nose-finger
testing. Brain magnetic resonance imaging revealed an
acute right cerebellar infarct secondary to nonocclusive
right sigmoid sinus and internal jugular vein thrombosis,
also confirmed on computed tomography (Figure 1,
Figure 2). The patient was also found to have multiple
pulmonary septic emboli (Figure 3).

For the diagnosis and teaching points, see page 560.

Figure 2. Axial computed tomography venography of the brain To view the entire collection of Images in Emergency Medicine,
revealed a sigmoid sinus thrombus (white arrow). visit www.annemergmed.com

508 Annals of Emergency Medicine Volume 80, no. 6 : December 2022

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