Answer for BIR CoW 20 May 2018
Thrombosed orbital varix
Findings
Right proptosis. T1,T2 hetero-intense soft tissue intensity lesion noted involving intraconal & extraconal compartments of superonasal quadrant of right orbit. Partially thrombosed dilated tortuous superior ophthalmic vein seen passing through the lesion. The lesion causes inferolateral deviation of right eye ball & scalloping of lamina papyracea. Extra ocular muscles & optic nerve on right side appear normal.
Discussion
The Orbital Varices are unusual lesions causing transient positional exophthalmos. They can be simple (dilatation of a single venous vessel) or complex (due to enlargement of multiple venous channels). Mostly congenital, the Orbital Varix is usually unilateral. They typically manifest in the 2nd or 3rd decade of life. The lesions result from a presumably congenital weakness in the post capillary venous wall, a condition that leads to the proliferation of venous elements and massive dilatation of the valveless orbital veins. Patients suffering from intermittent proptosis accentuated by the Valsalva manoeuvre, coughing, inclining forwards straining, forced expiration or jugular vein compression, are strongly suspected of having an Orbital Varix. Proptosis that occurs in association with thrombosis or hemorrhage is rapid, more sustained and painful. In fact, the Orbital Varix usually collapses when jugular vein pressure becomes lower (such as in the supine position during a standard CT or MRI examination), being completely undetected. Due to the lack of valves in the facial venous system, the mild physiological venous hypertension related to the prone position is able to distend orbital varicoid channels, making MR a highly reliable imaging technique in OV diagnosis. IMAGING: At MR imaging, varices have hypo- to hyperintense signal on T1-weighted images, have hyperintense signal on T2-weighted MR images, and usually enhance intensely after the administration of contrast material. Varices may be smooth contoured, clublike, triangular, or segmentally dilated, or they may appear as a tangled mass of vessels. Variable areas of nonenhancement: Areas of thrombosis or acute hemorrhage. Cystic or lymphatic spaces. Heterogeneous fast or turbulent flow void.
Findings
Right proptosis. T1,T2 hetero-intense soft tissue intensity lesion noted involving intraconal & extraconal compartments of superonasal quadrant of right orbit. Partially thrombosed dilated tortuous superior ophthalmic vein seen passing through the lesion. The lesion causes inferolateral deviation of right eye ball & scalloping of lamina papyracea. Extra ocular muscles & optic nerve on right side appear normal.
Discussion
The Orbital Varices are unusual lesions causing transient positional exophthalmos. They can be simple (dilatation of a single venous vessel) or complex (due to enlargement of multiple venous channels). Mostly congenital, the Orbital Varix is usually unilateral. They typically manifest in the 2nd or 3rd decade of life. The lesions result from a presumably congenital weakness in the post capillary venous wall, a condition that leads to the proliferation of venous elements and massive dilatation of the valveless orbital veins. Patients suffering from intermittent proptosis accentuated by the Valsalva manoeuvre, coughing, inclining forwards straining, forced expiration or jugular vein compression, are strongly suspected of having an Orbital Varix. Proptosis that occurs in association with thrombosis or hemorrhage is rapid, more sustained and painful. In fact, the Orbital Varix usually collapses when jugular vein pressure becomes lower (such as in the supine position during a standard CT or MRI examination), being completely undetected. Due to the lack of valves in the facial venous system, the mild physiological venous hypertension related to the prone position is able to distend orbital varicoid channels, making MR a highly reliable imaging technique in OV diagnosis. IMAGING: At MR imaging, varices have hypo- to hyperintense signal on T1-weighted images, have hyperintense signal on T2-weighted MR images, and usually enhance intensely after the administration of contrast material. Varices may be smooth contoured, clublike, triangular, or segmentally dilated, or they may appear as a tangled mass of vessels. Variable areas of nonenhancement: Areas of thrombosis or acute hemorrhage. Cystic or lymphatic spaces. Heterogeneous fast or turbulent flow void.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!