Traumatic carotid-cavernous fistula: excellent demonstration on 3D CT angiography.

To cite: Goyal A, Sharma S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201707 DESCRIPTION A 32-year-old man, presented with right proptosis, chemosis and double vision since 2 months. There was a history of head injury following a road traffic accident 3 months ago, but no records were available. On examination, there was pulsatile proptosis, audible bruit and raised intraocular pressure. The patient underwent a dual-phase CT on a 16-slice scanner (Brilliance CT 16, Philips). A non-ionic iodinated contrast 60 mL (iodine 300 mg/mL) was injected through an intravenous cannula at 4 ml/s using a pressure injector followed by 30 mL saline flush at the same rate. CT acquisition was triggered using bolus tracking with 4 s delay for arterial phase and 5 s interscan delay for venous phase. Scans were obtained with a detector collimation of 16×0.75 mm at 120 kV and 150 mAs. Coronal and sagittal multiplanar reformats, maximal intensity projections and three-dimensional (3D) volume rendering technique (VRT) were used for postprocessing. In the arterial phase (CT angiogram), there was contrast opacification of the right cavernous sinus (CS), the superior ophthalmic vein (SOV) and Figure 1 Frontal view of three-dimensional CT angiogram obtained with volume rendering technique (VRT) depicts tortuously enlarged right superior ophthalmic vein at the superior orbital fissure. Right angular veins and bilateral draining superficial facial veins are also engorged. Note made of a fracture mid-shaft of the right clavicle. VRT image with soft tissues included, shows right lid swelling in inset.