ORBITAL VENOUS ANOMALIES DEMONSTRATED BY SPIRAL COMPUTED-TOMOGRAPHY

Citation
Pad. Rubin et Hd. Remulla, ORBITAL VENOUS ANOMALIES DEMONSTRATED BY SPIRAL COMPUTED-TOMOGRAPHY, Ophthalmology, 104(9), 1997, pp. 1463-1470
Citations number
35
Categorie Soggetti
Ophthalmology
Journal title
ISSN journal
01616420
Volume
104
Issue
9
Year of publication
1997
Pages
1463 - 1470
Database
ISI
SICI code
0161-6420(1997)104:9<1463:OVADBS>2.0.ZU;2-2
Abstract
Objective: To describe the radiographic appearance of acute hemorrhage in orbital venous malformations and how spiral computed tomography (C T) can aid in the diagnosis of these lesions in patients with atypical presentations. Design: Case series from the Eye Plastics and Orbital Service of Massachusetts Eye and Ear Infirmary. Participants/Intervent ion/Main Outcome Measures: Three patients who initially presented with signs and symptoms of orbital hemorrhage are presented, Their initial clinical and radiologic imaging, follow-up examination, and results o f the spiral CT are summarized. Results: The initial CT in each case s howed a well-localized homogeneous mass in the posterior/inferior orbi t, In the two cases without antecedent trauma, it was difficult to dis tinguish these localized hemorrhages from possible intraorbital neopla sm. On resolution of the hemorrhage, these three patients had differen t presentations. The first patient had intermittent proptosis that was documented by increase in exophthalmometry measurement before and aft er Valsalva maneuver (symptomatic and with clinical signs). The second patient had a subjective orbital pressure sensation, but no visible c hange by examination (symptomatic but without clinical signs). The thi rd patient was not symptomatic and had no significant clinical finding s (asymptomatic and without clinical signs), Spiral CT showed the pres ence of an enlarging inferior orbital mass during Valsalva maneuver, w hich was not apparent pre-Valsalva in all these patients. Conclusions: Localized hemorrhages easily may be mistaken for solid intraorbital m asses; therefore, accurate determination can avoid unnecessary surgica l intervention, Patients with orbital venous malformation may or may n ot have symptoms and clinical signs of intermittent proptosis, After t he resolution of the initial hemorrhage, spiral CT during Valsalva man euver using a single breath hold technique is useful in showing the pr esence of this venous anomaly when suspicious of this entity, even in patients who are asymptomatic.