1. PENN RADIOLOGY THE ROOTS OF RADIOLOGICAL EXCELLENCE Traumatic thrombosis of posterior condylar vein with extension to internal jugular vein Abstract No: EE-09 Authors: S.Ali Nabavizadeh MD, Aaron Bress DO, Bryan Pukenas MD Neuroradiology Division Department of Radiology University of Pennsylvania

2. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Disclosure statement Neither the authors nor their immediate family members have a financial relationship with a commercial organization that may have a direct or indirect interest in the content.Neither the authors nor their immediate family members have a financial relationship with a commercial organization that may have a direct or indirect interest in the content.

3. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Overview PurposePurpose Case ReportCase Report Imaging FindingsImaging Findings SummarySummary

4. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn RadiologyPurpose The posterior condylar canal is located posterior to the occipital condyle and transmits the posterior condylar vein which is one of the largest emissary veins in the retromastoid region. The posterior condylar vein exits the skull through the posterior condylar canal, which is a communication between the jugular foramen and the condylar fossa, situated just posterior to the occipital condyles on either side of the foramen magnum. This canal allows for venous anastomosis between the jugular bulb and the suboccipital venous plexus

5. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Purpose We report a patient with an occipital bone fracture coursing through the posterior condylar canal causing thrombosis of posterior condylar vein with extension to internal jugular vein.

6. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Case report A 50 year old patient was brought to the emergency department following a fall from 15 steps.

7. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Imaging findings Initial head CT scan demonstrated a linear occipital bone fractures extending to the posterior condylar vein on the right side. There was no extension of fracture line to the major dural venous sinuses. Subsequent CT venography demonstrated thrombosis of right posterior condylar vein with extension to upper aspect of right internal jugular vein causing non-occlusive thrombosis. Patient was managed conservatively with no evidence of hemorrhagic infarction or clot extension on follow-up imaging.

8. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology C Axial CT scan demonstrates linear occipital bone fracture with extension to the right posterior condylar canal (A, arrow). Axial and sagittal oblique CTV (B and C) demonstrate right condylar vein thrombosis (arrow) with extension to right internal jugular vein (D, arrow). AB

9. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Summary The role of traumatic close head injuries as an important etiology of cerebral venous sinus thrombosis has been demonstrated in multiple studies. In these studies, the criteria for performing CTV was extension of skull fracture line to the major dural venous sinuses including superior sagittal sinus, transverse sinus, sigmoid sinus, or jugular bulb.

10. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology

11. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Summary To the best of our knowledge traumatic thrombosis of posterior condylar vein with subsequent extension to major venous sinuses has not been reported yet in English literature. Increase awareness of radiologists to this anatomical structure and routine CT venograms for concerning skull fractures is important for appropriate diagnosis.

12. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology References 1.Ginsberg LE. The posterior condylar canal. AJNR. 1994 May;15(5):969- 72. 2. Delgado Almandoz JE, Kelly HR, Schaefer PW, et al. Prevalence of traumatic dural venous sinus thrombosis in high-risk acute blunt head trauma patients evaluated with multidetector CT venography. Radiology 2010; 255(2):570–577. 3. Rivkin MA, Saraiya PV, Woodrow SI. Sinovenous thrombosis associated with skull fracture in the setting of blunt head trauma. Acta Neurochir (Wien). 2014 May;156(5):999-1007.

13. Baltimore, Maryland Perelman School of Medicine at University of Pennsylvania Penn Radiology Thank You  seyedali.nabavizadeh@uphs.upenn.edu seyedali.nabavizadeh@uphs.upenn.edu