Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Orbital and Scalp Hematoma
Joseph Junewick, MD FACR
over 10 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Carotid-Cavernous Sinus Fistula

Case Detail

Anatomy: Neck-Face
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: CT IR
Adobe32 PDF Imagej32 ImageJA


12 year old female with proptosis and chemosis 1 month after resection of pituitary macroadenoma.

Case Images


Carotid-Cavernous Sinus Fistula


CT – Right proptosis, dilated superior ophthalmic vein and enlargement of the ocular muscles.

IR – Right internal carotid injection demonstrates opacification of an enlarged right cavernous sinus and superior ophthalmic vein on arterial phase imaging.


A carotid cavernous fistula is an abnormal connection between the internal or external carotid artery and the cavernous sinus. These may result from direct trauma, surgery, dural sinus thrombosis, or atherosclerosis or may occur spontaneously; spontaneous fistulas have been seen in people with Ehlers-Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum.

Symptoms include proptosis, conjunctival chemosis, decreased visual acuity, and ausculatory bruit.

The imaging findings on CT or MRI angiography can include dilated superior opthalmic vein, retrobulbar fat stranding, proptosis, cavernous sinus dilation, and congestive extraocular muscle enlargement. Convential angiography demonstrates rapid early filling of the cavernous sinus with retrograde filling of the ipsilateral superior opthalmic vein. Catheter directed angiography with embolization is the mainstay of treatment. This can be achieved either tranarterial or transvenously with detachable balloons or coils.


Razek AA, Castillo M. Imaging lesions of the cavernous sinus. Am J Neuroradiol. 2009 Mar;30(3):444-452.

Smoker, W, et al. Vascular Lesions of the Orbit: More than Meets the Eye. January 2008 RadioGraphics, 28, 185-204.

Strother, CM, et al. Endovascular Treatment of High-Flow Carotid Cavernous Fistulas by Stent-Assisted Coil Placement. Am J Neuroradiol. 2005 Jun; 26:1399-1404.


Jennifer Rollenhagen MD

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare