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Show f. Clin. Neuro-ophthafmof, 3: 83, 1983, Editorial Enlarged Superior Ophthalmic Veins Moster and Kennerdell, in this issue of the Journal, emphasize the usefulness of B-scan ultrasound in detecting the presence of a dilated superior ophthalmic vein, They draw particular attention to the association of enlarged superior ophthalmic veins with dural sinus fistulae, We think their report brings out an important clinical use for B-scan ultrasound, However, we believe it is important to note that an enlarged superior ophthalmic vein, particularly as seen on high-resolution computed tomography after contrast enhancement, is not restricted to nor pathognomonic for a dural sinus fistula, It can, however, occur with other entities, The following table prepared by one of us (R.M,Q,) may be of help in differential diagnosis when confronting a patient with an enlarged superior ophthalmic vein, June 1983 Causes for Superior Ophthalmic Vein Enlargement I. Vascular masses of the cavernous sinus with increased retro~rade venous flow a. Carotid cavernous fistula b. Arteriovenous dural malformations or fistula II. Vascular masses of the orbits or periorbital region with incre.lSed antegrade venous flow a, Orbit,,1 arteriovenous malformations b, Vascular tumor (i,e., hemangiopericytoma, or highly vascular metastasis) III. Varix of the superior ophthalmic vein IV. Venous congestion of the orbit secondary to an inflammatory process or neoplasm at orbital apex or in cavernous sinu5 One of us (N,J.S,) also proposed that the four most common causes of superior ophthalmic vein enlargement usually seen in neuro-ophthalmologic consultative practice would probably be: 1) thyroid eye disease, 2) dural sinus fistula, 3) Tolosa-Hunt syndrome, and 4) varix of superior ophthalmic vein, J. L Smith, M.D. R. M. Quencer, M.D. N. J. Schatz, M. D. (by invitation) 83 |
