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Visualization of bilateral carotid cavernous sinus fistulas with duplex sonography
Author(s) -
Sanden Ulrike,
Grosse Uwe,
Jaksche Hans
Publication year - 2003
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.10175
Subject(s) - medicine , cavernous sinus , circle of willis , radiology , digital subtraction angiography , carotid cavernous fistula , inferior petrosal sinus , carotid cavernous sinus fistula , blood flow , straight sinus , angiography , surgery , thrombosis , superior sagittal sinus
Duplex sonography used as a primary diagnostic tool in the case of a 17‐year‐old boy with a traumatic head injury revealed bilateral carotid cavernous sinus fistulas, with bilateral dilated venous convolutions next to the carotid siphon and dilated superior ophthalmic veins. A bilateral craniectomy allowed visualization of the entire circle of Willis together with the dilated cavernous sinuses. Doppler spectral analysis of blood flow in the arterialized superior ophthalmic veins revealed an arterialized venous pattern with retrograde and increased blood flow. The same blood flow profile was found in the venous cavernous sinuses. These findings were confirmed by digital subtraction angiography. We planned to perform embolization of the patient's fistulas, but intracranial and subarachnoid hemorrhaging developed, and the patient died the day before the procedure was to have been performed. The entire pathologic state of carotid cavernous sinus fistulas, from their origin beside the carotid siphon to the superior ophthalmic veins, can be visualized with duplex sonography, particularly when patients have undergone craniectomy. We believe that patients with frontal or basilar skull fracture should undergo duplex sonographic examination to detect carotid cavernous sinus fistulas. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:319–323, 2003