Presentation
Presented to the emergency department with chief complaint of bilateral, left greater than right, eye swelling and pain since she woke up in the morning. The pain was worse with lateral and medial gaze. The patient also had intermittent episodes of blurry vision and multiple episodes of vomiting. The pain and blurry vision was relieved by looking straight ahead. Patient denied photophobia or prior similar episodes. The review of systems was otherwise noncontributory.
Patient Data
ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org.
Non-contrast CT of the Orbits reveals a hyperdense, well circumscribed mass, centered within intraconal compartment of the left orbit. The density of the mass measured approximately 80 HU, which is compatible with acute thrombus. There is associated mass effect upon left optic nerve with medial displacement.
MRI of the brain demonstrates a left, well circumscribed, intraconal mass with T1WI and T2WI signal intensity isointense to cerebral cortex. After administration of gadolinium based contrast, the mass showed thin smooth rim enhancement with a predominately non-enhancing central component consistent with thrombosed orbital varix. Incidentally, also revealed is a small homogeneously enhancing mass in the right orbit that is a smaller patent orbital varix.
Case Discussion
Orbital varix is an abnormally enlarged vein that accounts for less than 1.3% of all orbital masses. They are the most common cause of spontaneous orbital hemorrhage (Mafee). It may be a single vessel with saccular or segmental dilatation or tangled plexus of venous channels. Classically, they present in the 2nd and 3rd decade of life and occur equally in males and females (Rubin). Presenting symptoms are typically intermittent diplopia or proptosis during of straining or prone position. Hemorrhage or thrombosis are possible complications that may present with acute orbital pain, diplopia, proptosis or decreased visual acuity (Rubin).
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