Direct Carotid-Cavernous Fistula

Middle aged male suffered a blow to the head. A day later complained of eye pain and swelling.


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Six images from a left internal carotid artery injection, the first unsubtracted to show the level of injection. The fourth image demonstrates abnormal filling of the cavernous sinus. Later in the injection, other venous structures start to fill, first the petrosal sinus and then the jugular veins.



The above four images are an injection with the cavernous sinus centered in the field of view, which better shows the abnomality.



The above four images are an oblique projection. Note the concurrent filling of both venous structures and arterial structures, a hallmark of arterio-venous fistulas.