Idiopathic Orbital Inflammatory Disease Mimicking a Carotid Cavernous Fistula

Nurhayati Abdul Kadir¹, Syed Shoeb Ahmad^1, and Shuaibah Abdul Ghani¹

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

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

Copyright

This 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/

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