Carotid cavernous fistula masquerading as orbital inflammation on noninvasive imaging in a peripartum patient

Main Article Content

Lucy V. Cobbs, MD
Young Sheng, BA
Sarah E. Amanullah, MD
Cathy Y. Zhang, MD
Charles Brodowski, MD
Sathyadeepak Ramesh, MD

Abstract

A carotid cavernous fistula (CCF) is a pathological connection between the internal or external carotid artery and the cavernous sinus venous system. Pregnancy has been proposed as a risk factor for spontaneous CCF, but the exact mechanism of risk is unknown. Overall, there are few published reports describing CCF in pregnancy. Study of this risk factor relationship is further complicated by potential ambiguity in diagnosing CCF, which may present as subtle, nonspecific findings on initial workup. We report a case of CCF during pregnancy in which the diagnostic process was notable for misleading, noninvasive, imaging studies.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Cobbs LV, Sheng Y, Amanullah SE, Zhang CY, Brodowski C, Ramesh S. Carotid cavernous fistula masquerading as orbital inflammation on noninvasive imaging in a peripartum patient. Digit J Ophthalmol. 2023;29(2):31-35. doi:10.5693/djo.02.2022.11.001
Section
Case Reports

References

Walker AE, Allegre GE. Carotid-cavernous fistulas. Surgery 1956;39:411-22.

Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014;130:1003-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.009029

Yeung SW, Suen SS, Yu SC, Lao TT, Leung TY, Lau TK. Spontaneous carotid cavernous fistula complicating pregnancy. Hong Kong Med J 2013;19:258-61. DOI: https://doi.org/10.12809/hkmj133634

Dos Santos D, Monsignore LM, Nakiri GS, Cruz AA, Colli BO, Abud DG. Imaging diagnosis of dural and direct cavernous carotid fistulae. Radiol Bras 2014;47:251-5. DOI: https://doi.org/10.1590/0100-3984.2013.1799

Srinivasan A, Biro NG, Murchison AP, et al. Efficacy of orbital color doppler imaging and neuroimaging in the diagnosis of carotid cavernous fistulas. Ophthal Plast Reconstr Surg 2017;33:340-4. DOI: https://doi.org/10.1097/IOP.0000000000000781

Rahman WT, Griauzde J, Chaudhary N, Pandey AS, Gemmete JJ, Chong ST. Neurovascular emergencies: imaging diagnosis and neurointerventional treatment. Emerg Radiol 2017;24:183–193. DOI: https://doi.org/10.1007/s10140-016-1450-x

Rucker JC, Biousse V, Newman NJ. Magnetic resonance angiography source images in carotid cavernous fistulas. Br J Ophthalmol 2004;88:311. DOI: https://doi.org/10.1136/bjo.2003.026575

Chen CC, Chang PC, Shy CG, Chen WS, Hung HC. CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques. AJNR Am J Neuroradiol 2005;26:2349-56.

Williams ZR. Carotid-cavernous fistulae: a review of clinical presentation, therapeutic options, and visual prognosis. Int Ophthalmol Clin 2018;58:271-94. DOI: https://doi.org/10.1097/IIO.0000000000000215

Kadir NA, Syed S, Ahmad, et al. Orbital inflammatory disease mimicking a carotid cavernous fistula. Am J Med Case Rep 2016;4:122-5.

Baharuddin N, Nor-Fadzillah AJ, Raja-Norliza RO, Alice GKC, Zunaina E. Diagnostic dilemma of dural carotid cavernous fistula. J Biomed Clin Sci 2017;2:38-41.