Orbital venous varix

Case contributed by Ahmed Al-Dhahli

Presentation

Blunt trauma

Patient Data

Age: 90 years
Gender: Female
CT

Non Contrast Head CT

Incidental finding of a well-defined mass in the intraconal compartment of the right orbit exerting mild mass effect on the upper rectus muscle and the optic nerve. The remainder of the right orbit is normal with no fat stranding. Right occipital bone craniotomy for remote resection of vestibular schwannoma. 

MRI

Orbit MRI study with contrast performed after 3 months

MRI orbit study performed 3 months after the CT head study showed non-visualization of the right orbital mass. There is, however, slight enophthalmos on the right, a common finding in orbital varix when collapsed. 

Postoperative findings in the right posterior fossa with small enhancing lesion in the right cerebellopontine angle denoting known residual vestibular schwannoma. 

Case 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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Case information

rID: 76974
Published: 7th Dec 2020
Last edited: 12th Dec 2020
Inclusion in quiz mode: Included
Institution: McGill University

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