Ethmoid and sphenoid sinusitis complicated by cavernous sinus thrombosis and ischemic infarction

Pre-contrast (A, C) and post-contrast (B, D, and E) MR images show mild enlargement of both cavernous sinuses that contain filling-defects (dashed arrows) consistent with thrombi. Enhancement of left posterior ethmoid and both sphenoid paranasal sinus walls (arrows) is consistent with bacterial sinusitis.
Trace diffusion-weighted (F, G) MR images show hyperintense signal in paranasal sinuses (arrows) and bilateral cavernous sinuses (dashed arrows). In addition, abnormal hyperintense signal extends dorsally into pre-pontine and ambient cisterns (arrowheads), consistent with infection. Reduced diffusivity in head of hippocampus (thick arrow) indicates acute ischemic infarction of left anterior choroidal artery.