Orbital venous varix

Discussion:

The patient with a history of remote partial resection of right vestibular schwannoma presents with blunt trauma. CT Head examination was negative of acute traumatic injury and an incidental finding of a well-defined intraconal mass in the right orbit was identified. MRI was requested which was done which demonstrated complete resolution of the right orbital mass without medical or surgical treatment. Findings are compatible with orbital venous varix and supported by the presence of enophthalmos on the prior MRI. 

Although orbital venous varices are uncommon, They are considered the main etiology for spontaneous orbital hemorrhage. Patients in their 2nd or 3rd decades are usually affected and usually present with stress proptosis which is associated with situations that increase the venous pressure including coughing and Valsalva maneuver. The superior ophthalmic vein is commonly affected. The proptosis and imaging findings may resolve as in our case if venous hypertension has been normalized.  

The diagnosis can be established by performing CT with and without Valsalva. 

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