Superior sagittal sinus filling defect in metastatic lung cancer: tumour thrombus, bland thrombus or both?

In patients with active malignancy, dural venous sinus filling defects have a broad differential that includes bland cerebral venous sinus thrombosis, tumour thrombus and benign anatomic variants, each with distinct management implications.Magnetic resonance imaging findings may be indeterminate; confirmatory vascular imaging with computed tomography angiography or computed tomography venography is often necessary before initiating or continuing systemic anticoagulation.Anticoagulation decisions should be individualised, particularly in patients with altered gastrointestinal anatomy or malabsorption, where direct oral anticoagulant efficacy may be unreliable.