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Joseph Junewick, MD FACR
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Carotid-Cavernous Sinus Fistula

Case Detail

Anatomy: Neck-Face
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: CT IR
Activities:
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History

12 year old female with proptosis and chemosis 1 month after resection of pituitary macroadenoma.


Case Images


Diagnosis

Carotid-Cavernous Sinus Fistula

Findings

CT – Right proptosis, dilated superior ophthalmic vein and enlargement of the ocular muscles.

IR – Right internal carotid injection demonstrates opacification of an enlarged right cavernous sinus and superior ophthalmic vein on arterial phase imaging.

Discussion

A carotid cavernous fistula is an abnormal connection between the internal or external carotid artery and the cavernous sinus. These may result from direct trauma, surgery, dural sinus thrombosis, or atherosclerosis or may occur spontaneously; spontaneous fistulas have been seen in people with Ehlers-Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum.

Symptoms include proptosis, conjunctival chemosis, decreased visual acuity, and ausculatory bruit.

The imaging findings on CT or MRI angiography can include dilated superior opthalmic vein, retrobulbar fat stranding, proptosis, cavernous sinus dilation, and congestive extraocular muscle enlargement. Convential angiography demonstrates rapid early filling of the cavernous sinus with retrograde filling of the ipsilateral superior opthalmic vein. Catheter directed angiography with embolization is the mainstay of treatment. This can be achieved either tranarterial or transvenously with detachable balloons or coils.

Reference

Razek AA, Castillo M. Imaging lesions of the cavernous sinus. Am J Neuroradiol. 2009 Mar;30(3):444-452.

Smoker, W, et al. Vascular Lesions of the Orbit: More than Meets the Eye. January 2008 RadioGraphics, 28, 185-204.

Strother, CM, et al. Endovascular Treatment of High-Flow Carotid Cavernous Fistulas by Stent-Assisted Coil Placement. Am J Neuroradiol. 2005 Jun; 26:1399-1404.

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Jennifer Rollenhagen MD



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