PMC6091331_01
High-resolution CT showing area suspicious for a small skull base defect (yellow arrow) and adjacent opacification in the posterior ethmoid sinus (red arrow).
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CT imaging showed an air-fluid level within a left posterior ethmoid air cell with an apparent 2 mm adjacent osseous dehiscence along the fovea ethmoidalis, suspicious for the source of the CSF leak in this patient (Figure 1). Inspissated mucus was found at the area of mucosal thickening on CT (Figure 1) without evidence of fluorescein-dyed cerebrospinal fluid or bony dehiscence at the fovea ethmoidalis.
Endoscopic identification of fluorescein-dyed CSF in the oropharynx.
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Close inspection of the mid-oropharynx, however, revealed a bulge in the posterior oropharynx, and a small, pinpoint fistula with actively leaking fluorescein-dyed CSF was found (Figure 2).
CT neck showing cervical hardware with thinning of the oropharyngeal mucosa. CT myelogram was negative for leak in this region.
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The CT scan of the neck region was reviewed to evaluate the cervical hardware (Figure 3), and the head and neck surgery team was asked to assist neurosurgery with repair of the fistula.