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Connor Nathe, Seanna R Grob, Jeremiah Tao, Kenneth Feldman; Peripheral rim enhancement: a radiographic clue for diagnosis of thrombosed orbital varices. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5625.
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Thrombosed orbital varices are rare orbital lesions, and key clinical features can aid in clinical diagnosis and subsequent management. We performed a retrospective case series to report the characteristic clinical and imaging findings in a series of patients with thrombosed orbital varices.
Clinical findings of 4 patients with thrombosed orbital varices managed by the oculoplastic service were reviewed including symptoms and signs on presentation, characteristic imaging findings, and clinical course. All patients had orbital magnetic resonance imaging (MRI) with contrast.
Four cases of orbital varices with acute thrombosis were identified. The mean age was 61.5 (range: 38-79 years) without a predisposition for gender. All patients presented with symptoms of acute pain. Other presenting symptoms and signs included pressure (1/4), diplopia (1/4), blurry vision (1/4) and proptosis (2/4). 1 of 4 patients showed clinical changes with Vasalva maneuver. CT imaging showed an orbital mass in all cases, but each case had variable radiographic features with CT imaging. All cases revealed a characteristic magnetic resonance imaging (MRI) finding of peripheral rim enhancement of the orbital soft tissue lesion. All patients were observed over time and had improvement in symptoms. One patient had two episodes of acute pain with similar imaging findings that resolved without intervention.
Patients with thrombosed orbital varices often present with acute pain and have a characteristic imaging finding on orbital MRI of peripheral rim enhancement. These key features can assist with the clinical diagnosis of a thrombosed orbital varix and aid in further clinical management.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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