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Empty delta sign

MedGen UID:
536121
•Concept ID:
C0234616
•
Sign or Symptom
SNOMED CT: Empty delta sign (35508004)
 
HPO: HP:0032267

Definition

This sign is created by a nonenhancing thrombus in the dural sinus surrounded by triangular enhancing dura as seen on cross-section. The sign, seen on contrast-enhanced CT scan images, suggests dural sinovenous thrombosis. It is best seen on wider window settings. It is a reliable sign of sinus thrombosis but is seen only in 25-30% of these cases. [from HPO]

Recent clinical studies

Etiology

Bright sinus appearance on arterial spin labeling MR imaging aids to identify cerebral venous thrombosis.
Kang JH, Yun TJ, Yoo RE, Yoon BW, Lee AL, Kang KM, Choi SH, Kim JH, Sohn CH, Han MH
Medicine (Baltimore) 2017 Oct;96(41):e8244. doi: 10.1097/MD.0000000000008244. PMID: 29019892Free PMC Article
Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting.
Rizzo L, Crasto SG, Rudà R, Gallo G, Tola E, Garabello D, De Lucchi R
Radiol Med 2010 Mar;115(2):313-25. Epub 2010 Jan 20 doi: 10.1007/s11547-010-0493-4. PMID: 20091136
Superior sagittal sinus thrombosis: subtle signs on neuroimaging.
Tang PH, Chai J, Chan YH, Chng SM, Lim CC
Ann Acad Med Singap 2008 May;37(5):397-401. PMID: 18536826
Incidence of the empty delta sign in computed tomography in the paediatric age group.
Davies RP, Slavotinek JP
Australas Radiol 1994 Feb;38(1):17-9. doi: 10.1111/j.1440-1673.1994.tb00117.x. PMID: 8147792
Superior sagittal sinus thrombosis.
Mohamed A, McLeod JG, Hallinan J
Clin Exp Neurol 1991;28:23-36. PMID: 1821832

Diagnosis

Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis.
Garland J, Kesha K, Vertes D, Modahl L, Milne D, Ruder T, Stables S, Tse R
Am J Forensic Med Pathol 2018 Dec;39(4):360-363. doi: 10.1097/PAF.0000000000000421. PMID: 30024432
Superior sagittal sinus thrombosis: subtle signs on neuroimaging.
Tang PH, Chai J, Chan YH, Chng SM, Lim CC
Ann Acad Med Singap 2008 May;37(5):397-401. PMID: 18536826
Neuroimaging of cerebral venous thrombosis.
Wasay M, Azeemuddin M
J Neuroimaging 2005 Apr;15(2):118-28. doi: 10.1177/1051228404272883. PMID: 15746223
The empty delta sign.
Yoshida S, Shidoh M
Neurology 2003 Jan 14;60(1):146-51. doi: 10.1212/wnl.60.1.146. PMID: 12525742
Incidence of the empty delta sign in computed tomography in the paediatric age group.
Davies RP, Slavotinek JP
Australas Radiol 1994 Feb;38(1):17-9. doi: 10.1111/j.1440-1673.1994.tb00117.x. PMID: 8147792

Therapy

Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting.
Rizzo L, Crasto SG, Rudà R, Gallo G, Tola E, Garabello D, De Lucchi R
Radiol Med 2010 Mar;115(2):313-25. Epub 2010 Jan 20 doi: 10.1007/s11547-010-0493-4. PMID: 20091136
High-dose heparin plus warfarin administration in non-traumatic dural sinuses thrombosis. A clinical and neuroradiological study.
Cipri S, Gangemi A, Campolo C, Cafarelli F, Gambardella G
J Neurosurg Sci 1998 Mar;42(1):23-32. PMID: 9766269

Prognosis

Bright sinus appearance on arterial spin labeling MR imaging aids to identify cerebral venous thrombosis.
Kang JH, Yun TJ, Yoo RE, Yoon BW, Lee AL, Kang KM, Choi SH, Kim JH, Sohn CH, Han MH
Medicine (Baltimore) 2017 Oct;96(41):e8244. doi: 10.1097/MD.0000000000008244. PMID: 29019892Free PMC Article
Neuroimaging of cerebral venous thrombosis.
Wasay M, Azeemuddin M
J Neuroimaging 2005 Apr;15(2):118-28. doi: 10.1177/1051228404272883. PMID: 15746223
Incidence of the empty delta sign in computed tomography in the paediatric age group.
Davies RP, Slavotinek JP
Australas Radiol 1994 Feb;38(1):17-9. doi: 10.1111/j.1440-1673.1994.tb00117.x. PMID: 8147792
Superior sagittal sinus thrombosis.
Mohamed A, McLeod JG, Hallinan J
Clin Exp Neurol 1991;28:23-36. PMID: 1821832
The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis.
Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S
Radiology 1987 Mar;162(3):779-85. doi: 10.1148/radiology.162.3.3809494. PMID: 3809494

Clinical prediction guides

Detection of superior sagittal sinus thrombosis on FDG PET.
Agrawal A, Agrawal R, Asopa R, Baghel NS
Clin Nucl Med 2009 Mar;34(3):161-3. doi: 10.1097/RLU.0b013e3181966fb3. PMID: 19352280
Neuroimaging of cerebral venous thrombosis.
Wasay M, Azeemuddin M
J Neuroimaging 2005 Apr;15(2):118-28. doi: 10.1177/1051228404272883. PMID: 15746223
Superior sagittal sinus thrombosis.
Mohamed A, McLeod JG, Hallinan J
Clin Exp Neurol 1991;28:23-36. PMID: 1821832
Appearance and disappearance of empty delta sign in superior sagittal sinus thrombosis.
Shinohara Y, Yoshitoshi M, Yoshii F
Stroke 1986 Nov-Dec;17(6):1282-4. doi: 10.1161/01.str.17.6.1282. PMID: 3810732

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