--- title: "Signs in Sigmoid Sinus Thrombosis | Delta Sign, Griesinger Sign & Picket Fence Fever" description: "Sigmoid sinus thrombosis signs: Delta imaging appearance, Griesinger mastoid edema, Picket Fence Fever pattern, their mechanisms, and key viva points." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/sigmoid-sinus-thrombosis-delta-griesinger-sign-picket-fence-fever" categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Otology"] video: "https://www.youtube.com/watch?v=rAc3mnS89fQ" image: "https://media.theentresident.com/og-images/sigmoid-sinus-thrombosis-delta-griesinger-sign-picket-fence-fever.png" --- # Signs in Sigmoid Sinus Thrombosis | Delta Sign, Griesinger Sign & Picket Fence Fever Sigmoid sinus thrombosis signs: Delta imaging appearance, Griesinger mastoid edema, Picket Fence Fever pattern, their mechanisms, and key viva points. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=rAc3mnS89fQ ## Signs in Sigmoid Sinus Thrombosis Several classical signs are associated with **lateral (sigmoid) sinus thrombosis**. In this post, we will discuss: * Delta Sign * Griesinger Sign * Picket Fence Fever --- ### Delta Sign #### 📌 Type of Sign 👉 Radiological Sign seen on: * Contrast enhanced CT (CECT) * MRI #### 📌 Also Known As 👉 Empty Triangle Sign #### 🔍 What is the Sign? Delta Sign refers to a **triangular filling defect within the dural venous sinus, surrounded by contrast enhancement**. It is seen as: * Central low density * Triangular rim enhancement around it Seen in **Lateral Sinus Thrombosis**. > Which section of CT Scan is it seen in? > What is the reason behind Delta sign? #### 🔺 Why is it Called Delta Sign? The appearance resembles a **triangle (delta)**, hence the name **Delta Sign**. As it looks like an empty triangle, it is also called the **Empty Triangle Sign**. > What is the most common cause of lateral sinus thrombosis? --- ### Griesinger Sign #### 📌 Type of Sign 👉 Clinical Sign seen during **Mastoid examination**. #### 🔍 What is the Sign? Griesinger Sign refers to **edema of the post-auricular soft tissues overlying the mastoid process**, due to **thrombosis of the mastoid emissary vein**. Tenderness is also present over this area. Seen in **Lateral Sinus Thrombosis**. > What is the pathogenesis involved in Griesinger Sign? #### 👨‍⚕️ Eponym Named after Griesinger, who described mastoid region edema due to mastoid emissary vein thrombosis in sigmoid sinus thrombosis. --- ### Picket Fence Fever #### 📌 Type of Sign 👉 Clinical Sign #### 🔍 What is the Sign? Picket Fence Fever refers to a **characteristic fever pattern with spikes of high temperature separated by normal or near-normal readings**. Seen in **Lateral Sinus Thrombosis**. #### 🧠 Why Does it Occur? Fever spikes are due to **Septicemia**. * Septicemia coincides with **release of septic emboli** into the bloodstream * Each release of septic emboli → A spike in temperature * Temperature then returns to normal > What are the Features of Picket Fence Fever? #### 🪵 Why is it Called Picket Fence Fever? The temperature chart, with repeated high spikes separated by normal readings, resembles **a picket fence**, hence the name **Picket Fence Fever**. #### ⚠️ Important Viva Pearl Picket Fence Fever is ❌ Not seen in every case of lateral sinus thrombosis Patients who have started receiving **antibiotics** may not show this fever pattern. --- ### ⭐ High Yield Rapid Revision Table | Sign | Type | Finding | Cause | | --- | --- | --- | --- | | Delta Sign | Radiological | Triangular filling defect with rim enhancement on CECT / MRI | Thrombus in dural venous sinus | | Griesinger Sign | Clinical | Edema of post-auricular soft tissue over the mastoid | Thrombosis of mastoid emissary vein | | Picket Fence Fever | Clinical | High temperature spikes separated by normal readings | Septicemia with release of septic emboli | --- ### 🧠 Viva Pearls * Delta Sign, Griesinger Sign and Picket Fence Fever are seen in lateral sinus thrombosis. * Delta Sign is a radiological sign seen on contrast enhanced CT or MRI. * Delta Sign is also known as Empty Triangle Sign. * In the Delta Sign, the central non-enhancing area is the thrombus and the rim enhancement is the normal dura. * Griesinger Sign is edema over the mastoid due to thrombosis of the mastoid emissary vein. * Griesinger Sign is elicited during mastoid examination. * Picket Fence Fever is caused by septicemia with repeated release of septic emboli. * Picket Fence Fever is accompanied by chills, rigors and profuse sweating. * Picket Fence Fever may be absent in patients already on antibiotics. --- ## About This Note This free ENT note on Signs in Sigmoid Sinus Thrombosis | Delta Sign, Griesinger Sign & Picket Fence Fever was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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