Abstract
Arterialized blood flow in the cavernous sinus may result from carotid-cavernous fistula or dural venous fistula. We encountered an unusual case of arterialized blood flow in the cavernous sinus on MR angiography resulting from arterialized retrograde venous flow in the internal jugular vein. This abnormal flow originated from an upper extremity dialysis arteriovenous fistula in the presence of central venous occlusion. The patient's symptoms of visual disturbance resolved after the central venous occlusion was treated with stent placement.
Highlights
This showed abnormally increased signal intensity within the left cavernous sinus, the left transverse sinus, the left inferior petrosal sinus, and the ipsilateral superior ophthalmic vein
A36-year-old woman with a history of end stage renal disease, dialysis dependence, and left-arm arteriovenous (AV) fistula was hospitalized with vague abdominal pain and possible bowel obstruction
Arterialized blood flow in the cavernous sinus may be seen on MR angiography (MRA) as increased signal intensity
Summary
This showed abnormally increased signal intensity within the left cavernous sinus, the left transverse sinus, the left inferior petrosal sinus, and the ipsilateral superior ophthalmic vein. This signal intensity was interpreted as suggestive of carotid cavernous sinus fistula or dural venous fistula, and a catheter angiogram was recommended. Contrast injection of the aortic arch revealed normal great vessels, but the late arterial phase showed early flow into the left subclavian vein, as expected with AV fistula.
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