Two atypical cases of sinus thrombosis / by S.J. Kopetzky.

  • Samuel Joseph Kopetzky
Date:
1909
Catalogue details

Licence: In copyright

Credit: Two atypical cases of sinus thrombosis / by S.J. Kopetzky. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the first intimation that I had that I might be deal- ing with some sinus trouble, as previous observation on sinus cases had shown this finding in sinus in- volvement. This swelling should not be confused with the edema which results from a phlebitis of the mastoid emissary vein. (Annals of Otology, March, 1908.) The removal of the cortex showed the mastoid epophysis filled with fluid pus. 1 he cortex overlying the antrum was rather thick. The mastoid cells extended backward and upward rather unusually far and were found filled with necrotic debris and pus. The sinus took a course rather far forward and almost bisected in a diagonal direc- tion the mastoid process, cells being evident both above and below it. The sinus wall was covered with necrotic granulations and its exposure for considerable distance failed to show a healthy wall. The sinus was then opened at the level of the an- trum and found to contain a dark firm clot. The sinus was now traced backwards toward the torcu- lar for about an inch and a half, being opened all along its route, and free bleeding was obtained about one and one-half inches back from the knee. Working downward toward the bulb the central end of the clot was not reachable, therefore, after tem- porarily packing the mastoid cavity, re-sterilizing our hands and instruments, the neck was prepared for re-section of the jugular. The operation on the jugular was easily per- formed, the internal jugular resected from just above the clavicle to above the facial vein. The clot was now removed from the bulbar end of the sig- moid sinus and free bleeding followed, probably from the petrosal. Both wounds were cleansed, mas- toid wound packed in the usual manner and the lips of the neck wound approximated and ligated with three sutures, each having one surgical knot, leav- ing in situ .a strip of iodoform gauze to act as a drain. The neck wound rapidly healed, the mas- toid wound took the usual course and healed, the middle ear became dry without further incident. Patient eventually discharged cured.
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