American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2016, 4(4), 122-125
DOI: 10.12691/ajmcr-4-4-3
Open AccessCase Report

Idiopathic Orbital Inflammatory Disease Mimicking a Carotid Cavernous Fistula

Nurhayati Abdul Kadir1, Syed Shoeb Ahmad1, and Shuaibah Abdul Ghani1

1Ophthalmology Department, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

Pub. Date: April 22, 2016

Cite this paper:
Nurhayati Abdul Kadir, Syed Shoeb Ahmad and Shuaibah Abdul Ghani. Idiopathic Orbital Inflammatory Disease Mimicking a Carotid Cavernous Fistula. American Journal of Medical Case Reports. 2016; 4(4):122-125. doi: 10.12691/ajmcr-4-4-3

Abstract

Idiopathic orbital inflammatory disease (IOID) is a common orbital disorder. However, it has a highly variable clinical presentation depending on the site, degree of inflammation and size of the lesion, which produces a mass effect in the orbital cavity. IOID has no pathognomonic clinical features, thus radiologic and occasionally histopathologic studies are required to confirm the diagnosis of IOID. Here we report a case of a healthy elderly gentleman who presented to us with proptosis, dilated and tortuous conjunctival and retinal vessels and a positive response to Valsalva maneuver. These clinical features were suggestive of a carotid cavernous fistula (CCF). An initial CT scan showed an intraconal orbital mass. Hence, an MRI was subsequently performed which did not show features of CCF, however, there was again a large intraorbital mass noted. The radiologic differential diagnosis suggested was IOID, lymphoma and metastasis. Hence, a biopsy of the intraorbital mass through the transnasal approach was performed. That confirmed the lesion to be IOID and not CCF. Hence, although proptosis with conjunctival congestion, dilated tortuous conjunctival and retinal vessels with positive Valsalva maneuver are the usual clinical features of CCF, this case illustrates these features may also occur in patients with IOID.

Keywords:
orbital inflammatory pseudotumor carotid cavernous sinus fistula Valsalva maneuver inflammation proptosis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Chaudhry IA, Shamsi FA, Arat YO, Riley FC. “Orbital Pseudotumor: Distinct Diagnostic Features and Management.” Middle East Afr J Ophthal. 2008;15:17-27.
 
[2]  Gordon LK. “Orbital inflammatory disease: a diagnostic and therapeutic challenge.” Eye. 2006;20:1196-1206.
 
[3]  Yuen SJ, Rubin PA. “Idiopathic orbital Inflammation: Ocular mechanism and clinicopathology”. Ophthalmol Clin North Am. 2002;15:121-6.
 
[4]  Jacobs D, Galetta S. “Diagnosis and management of orbital pseudotumour”. Curr Opin Ophthalmol. 2002;13:347-51.
 
[5]  Swamy BN, McCluskey P, Nemet A, et al. “Idiopathic orbital inflammatory syndrome: Clinical features and treatment outcomes”. Br J Ophthalmol. 2007; 91:1667-70.
 
[6]  Miller NR. “Diagnosis and management of dural carotid-cavernous sinus fistulas”. Neurosurg Focus. 2007;23:E13.
 
[7]  Jianu, D. C., Jianu, S. N., Muresanu, D. F., et al. “Carotid-cavernous fistulas of low-flow type: Colour Doppler imaging of retrobulbar vessels findings”. Romanian J Neurology. 17 Suppl 3:567, September 2010.
 
[8]  Stanton DC, Kempers KG, Hendler BH, Cutilli BJ, Hurst RW. “Posttraumatic carotid-cavernous sinus fistula”. J Craniomaxillofac Trauma. 1999;5:39-44.
 
[9]  Mombaerts I, Goldschmeding R, Schlingemann RO, Koornneef L. “What is orbital pseudotumour?” Surv Ophthalmol 1996;41:66-78.