Presentation
Proptosis.
Patient Data
The cavernous sinuses, particularly on the right, are bulky, best seen on coronal post-contrast T1 images. This is associated with engorged superior ophthalmic veins and milt bilateral proptosis
On right carotid injections, multiple small branches opacify the ipsilateral cavernous sinus with filling of the contralateral cavernous sinus via the intercavernous sinuses. The left cavernous ICA can be seen as a filling defect within the left cavernous sinus. Drainage from the cavernous sinuses is primarily inferiorly through the inferior petrosal sinuses to the internal jugular veins. Reflux is also seen in the superior ophthalmic veins.
Case Discussion
Features are characteristic of indirect caroticocavernous fistula with prominent flow across to the contralateral cavernous sinus.
Followup and treatment are unfortunately not available.
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