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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 637

Boomerang sign on orbital ultrasound in carotid-cavernous fistula


Oculoplastic, Pediatric Ophthalmology and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication13-Apr-2022

Correspondence Address:
Sahil Agrawal
Senior Resident, Oculoplastic, Pediatric Ophthalmology and Tumor Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2695_21

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How to cite this article:
Modaboyina S, Das D, Bajaj MS, Agrawal S. Boomerang sign on orbital ultrasound in carotid-cavernous fistula. Indian J Ophthalmol Case Rep 2022;2:637

How to cite this URL:
Modaboyina S, Das D, Bajaj MS, Agrawal S. Boomerang sign on orbital ultrasound in carotid-cavernous fistula. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 24];2:637. Available from: https://www.ijoreports.in/text.asp?2022/2/2/637/342974

Sujeeth Modaboyina, Deepsekhar Das; Both the authors have equal contribution towards authorship.




The superior ophthalmic vein (SOV) courses posteriorly and laterally between superior rectus and the optic nerve, exiting through the superior orbital fissure before joining cavernous sinus [Figure 1]a and [Figure 1]b.[1] In cases of carotid-cavernous fistula (CCF), because of the flow disturbances in the cavernous sinus, SOV dilation is seen.[2] Orbital ultrasound with probe placed obliquely in the inferotemporal quadrant and indicator directed superiorly, dilated SOV can be noted as a boomerang-shaped [Figure 1]c and [Figure 1]d hypoechoic area along its natural course from medial to lateral side intraconally. This clinical sign using ultrasonography, a common tool for ophthalmologists, is important, especially in indirect fistulas where the giveaway sign of CCF, pulsatile proptosis, may be absent.[3]
Figure 1: (a) Clinical photograph of patient showing bilateral proptosis with chemosis. (b) T1-weighted (non-contrast) axial section of brain MRI and orbit MRI of the patient showing dilated bilateral SOV. (c) Image of a B/A Ultrasonogram of the patient showing a boomerang-shaped hypoechoic area in the superior aspect indicative of a dilated SOV. (d) Image of an actual boomerang

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  References Top

1.
Cheung N, McNab AA. Venous anatomy of the orbit. Invest Ophthalmol Vis Sci 2003;44:988-95.  Back to cited text no. 1
    
2.
Henderson AD, Miller NR. Carotid-cavernous fistula: Current concepts in aetiology, investigation, and management. Eye (Lond) 2018;32:164-72.  Back to cited text no. 2
    
3.
Chaudhry IA, Elkhamry SM, Al-Rashed W, Bosley TM. Carotid cavernous fistula: Ophthalmological implications. Middle East Afr J Ophthalmol 2009;16:57-63.  Back to cited text no. 3
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