Download - Orbital lesions ii
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ORBITAL IMAGING IIHEAD AND NECK IMAGING
EHAB ABOU ELFOTOUH. MD.
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Enlargementof the ophthalmic veins, causes: Orbital Varices.
Increased antero-grade flow, can result from vascular malformations of the face and scalp.
Obstruction of distal venous drainage, as cavernous sinus thrombosis.
Ab-normal retro-grade flow, as carotid–cavernous fistula.
Increased intracranial pressure.
Normal variant.
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Orbital Varices.
Most common cause of spontaneous orbital hemorrhage.
Lesions result from congenital weakness in post-capillary venous wall.
Have a large communication with the venous system and distend during maneuvers that increase venous pressure.
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Orbital Varices.
Have only a small communication with the venous system and do not distend.
Patients with usually manifest stress or painful proptosis.
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Orbital Varices.
CT images: Normal appearance,
axial on supine position.
Or mild enlargement of the involved veins.
Increases venous pressure is required to demonstrate lesion distensibility.
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Orbital Varices.
Varices may be smooth club-like, triangular, or segmental dilatation of Opth. veins.
Orbital mass of vessels.
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Orbital Varices.
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Orbital Varices.
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Orbital Varices.
At MR imaging:
Hypo- to hyper-intense signal on T1.
Hyper-intense signal on T2.
Intense enhancing pattern.
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Arteriovenous Fistulas:
Fed by ophthalmic artery branches.
Consist of multiple congenital micro-vascular connections between arteries and veins.
Manifest with peri-orbital swelling, dilated retinal veins, visible or palpable pulsations, an audible bruit, glaucoma, and, visual field defects.
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Wyburn-Mason Syndrome:
Oculocerebro-cutaneous syndrome.
Consists of unilateral AVM of the visual pathways and midbrain.
Facial vascular nevi or telangiectasias.
Patients present with intracranial hemorrhage, optic atrophy and pulsatile exophthalmos.
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Carotid Cavernous Fistulas:
Abnormal communication between the cavernous sinus and one or more branches of the internal or external carotid artery.
Causes direct trauma, surgery, dural sinus thrombosis, or spontaneously.
Spontaneous with Ehlers-Danlos syndrome and osteogenesis imperfecta.
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Carotid Cavernous Fistulas:
Manifest with the classic triad of pulsatile exophthalmos, conjunctival chemosis, and an auscultatory bruit.
Gradual decrease in visual acuity.
Palsy of cranial nerves III, IV, V, and VI.
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Carotid Cavernous Fistulas:
CT or MR imaging: Proptosis.
Extraocular muscle enlargement.
Superior ophthalmic vein distention.
Cavernous sinus dilatation .
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Cavernous Sinus Thrombosis:
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Cavernous Sinus Thrombosis:
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cavernous sinus thrombosis:
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Ophthalmic Artery Aneurysms:
Intracanalicular ophthalmic artery aneurysms are extremely rare.
More common carotid-ophthalmic artery aneurysms.
Arise at origin of the ophthalmic artery. May extend intra-cranially above the sella and
sometimes extend into or through optic canal. Lesion withdiameter of 2–3 mm are usually
asymptomatic. More than 3 mm may compress the artery or
optic nerve or rupture.
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*THANKS*