Presentation
Diplopia and proptosis.
Patient Data
contrast opacification identified within the left cavernous sinus and the engorged left orbital vein
the entire venous system on the left orbit and left cavernous sinus opacified with contrast on arterial phase CT, which indicates presence of caroticocavernous fistula; this has lead to distension of left ophthalmic and left facial vein
given a direct communication between the carotid and cavernous system is not definitely established on CT angiogram, this may reflect a dural shunt between the intracavernous branches of ICA (internal carotid artery) and cavernous sinus
no CT evidence of thyroid orbitopathy or orbital mass
Case Discussion
The patient presented with diplopia and proptosis. They had a history of recent insertion of a cardiac prosthesis which was a contraindication to have an MRI head, so the patient proceeded to have a CT head which showed slight enlargement of the left inferior rectus.
Later a CT angiogram of the circle of Willis was performed which showed findings that reflect a possible dural shunt between the intracavernous branches of the ICA and cavernous sinus or known as indirect carotid-cavernous sinus fistula (CCF).
This diagnosis was confirmed with a cerebral digital subtraction angiography (DSA) angiogram by a neurovascular interventionalist and the patient underwent embolization of the CCF with coils and coiling of superior and inferior ophthalmic veins.
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