Intraorbital arteriovenous fistula with thrombosed varix: Diagnosis and treatment without catheter angiography in a developing country (original) (raw)
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Thrombosis of intraorbital arterio-venous fistula
Neurosciences (Riyadh, Saudi Arabia), 2023
A 65-year-old male patient presented with a rare arterio-venous fistula (AFV). The symptoms included congestion, decreased visual acuity, and proptosis. Further investigation revealed a non-traumatic intra orbital AFV with ophthalmic vein thrombosis. The management strategy was craniotomy and the prescription of anticoagulants. The patient recovered 2 months after surgery demonstrating successful resolution of his presenting symptoms and an alternative approach to complicated cases of embolization.
Journal of Neurosurgery: Case Lessons
OBJECTIVE Orbital varix is a rare distensible orbital venous malformation. Most patients present with unilateral intermittent periorbital pain and positional proptosis that is exacerbated by the Valsalva maneuver. Complications include hemorrhage and thrombosis, leading to sudden painful proptosis and visual disturbance. OBSERVATIONS A 42-year-old female with a history of bilateral intermittent painless proptosis that was accentuated by a postural head-down position presented with acute painful proptosis in her right eye. Ophthalmic examination revealed right eye proptosis with a bluish mass at the right upper eyelid, and another bluish mass at the left lower eyelid that was prominent during the Valsalva maneuver. Computed tomography scans of the orbits indicated right orbital varix thrombosis and left orbital varix. Surgical excision of the right thrombosed varix was performed along with intralesional bleomycin injection in the left orbital varix. Histopathological examination conf...
Acta Medica Philippina, 2015
Dural arteriovenous fistulas (DAVF) are very uncommon vascular abnormalities whose incidence and pathogenesis are not completely known. They constitute 10-15% of all intracranial arteriovenous shunts, 1 however, because this condition can be clinically silent, the true incidence remains unknown. The reported annual morbidity and mortality rates of DAVFs with an aggressive presentation vary broadly, ranging from 1.8% to 20% per year. 2 DAVFs are arteriovenous shunts between abnormal arteries and veins contained within the dura. They may be congenital or acquired. The exact mechanism of their formation has not been well established; however, they are believed to be generally acquired most commonly from venous thrombosis. Case Presentation This is the case of a 45-year-old, right-handed, female Filipino who had been hypertensive for 3 years with poor compliance to medications. She presented with a 7-year history of a gradually enlarging superior orbital vein over the right upper eyelid with associated bruit and redness of her right eye (Figure 1). There was no history of trauma, no complaints of pruritus, ophthalmoplegia or proptosis. On consult with an ophthalmologist 5 years prior to admission, initial assessment was a possible carotico-cavernous fistula. She was advised to have an angiogram but was not able to have the procedure done due to financial difficulties.
SN Comprehensive Clinical Medicine, 2019
Orbital varices represent a rare type of venous malformation composed of a single or multiple abnormally enlarged veins communicating to the systemic venous system. Clinical presentation is often nonspecific. Potential complications including intraorbital bleed and venous thrombosis may lead to a permanent visual loss. Multimodality imaging is important for proper interpretation and accurate diagnosis as well as timely management of the lesion. We report two acute cases of bilateral and unilateral partially thrombosed orbital varices in which the correct diagnosis was made based on an integrated imaging approach.
Superior Ophthalmic Vein Thrombosis Associated with Orbital Inflammation
Advances in Ophthalmology & Visual System
We report a case of a 71 year old female who presented with redness, pain and periocular swelling in the left eye of 3 months duration and decreased vision and protrusion since 15 days. Previous ophthalmological history was unremarkable. The vision was PL negative. Examination showed moderate axial proptosis, mild ptosis, fullness of the eyelids, and a chemosed, prolapsed conjunctiva. Fundus examination showed a branch vein occlusion of the inferotemporal vein. There was total ophthalmoplegia OS. A provisional diagnosis of pseudotumour was made after basic investigations, and steroid therapy was initiated, but the patient showed little response. CT orbit showed left eye proptosis with minimal fat stranding and superior ophthalmic vein thrombosis which was confirmed by MRI. She also had an intracranial infarct which was picked up on MRI. Due to multiple vaso occlusive sites, and the lack of response to steroid therapy, she was referred for a haematological work up. Superior ophthalmic vein thrombosis, although rare, can be a harbinger of cavernous sinus thrombosis, hence the need for an urgent and detailed evaluation of orbital thrombosis.
Orbital varix thrombosis: a rare cause of unilateral proptosis
2013
Orbital varices are thin walled, low flow, distensible veins which may rarely present with periorbital pain, proptosis or visual loss. Most orbital varices may be managed conservatively and only warrant surgery in the presence of recurrent thrombosis, disfiguring proptosis or acute visual loss. This report concerns an 84-year-old Caucasian woman who was admitted following a fall and noted to have isolated proptosis of the right eye, with vertical diplopia. All biochemical and haematological investigations were normal. A CT scan of the orbits demonstrated a serpiginous soft tissue mass within the superior portion of the right orbit, consistent with a thrombosed orbital varix. Conservative management was agreed with prism glasses and ophthalmological follow-up.
Intraorbital Arteriovenous Fistula Secondary to Penetrating Injury
Ophthalmic Plastic & Reconstructive Surgery, 2007
To describe the clinical and radiologic features and management of an intraorbital arteriovenous fistula secondary to penetrating injury. Method: Interventional case report and literature review. Results: We describe a 13-year-old girl with a history of penetrating orbital injury who presented with proptosis, eyelid hyperemia, and orbital venous congestion. Computed tomography showed a large foreign body in the superiormedial orbit and an enlarged superior ophthalmic vein (SOV). Doppler ultrasonography revealed arterialized flow in the SOV. Removal of the foreign body did not alter the orbital symptoms. Carotid angiography disclosed a fistula between the ophthalmic artery and the SOV. The patient underwent an attempted coil embolization of the fistula through the femoral vein, which was unsuccessful, but she developed profound thrombosis of the SOV, which propagated through the orbital venous system. Although orbital venous congestive symptoms were acutely exacerbated, they regressed spontaneously within 1 month. The patient was followed for 23 months without recurrence. Conclusions: Penetrating injury of the orbital apex may lead to the formation of an arteriovenous fistula, transvenous embolization of which may be complicated by thrombosis of the SOV. In our case, this unintentional result facilitated the resolution of the fistula.