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Carotid - Cavernous Sinus Fistula

A 72 year-old man sustained a gunshot wound to the face while hunting. On examination, the left eye was proptotic with engorged veins around the eye. A loud bruit was heard over the left eye.

   Show the Internal Carotid Artery                         Show the Arteriovenous Fistula                  Show the Venous Drainage (Int. Jugular)

Note the Numerous Shadows from the "Buckshot"

Carotid - Cavernous Sinus Fistula: Internal Carotid Artery Angiogram, lateral view, three sequential images. Note the early opacification of the internal carotid artery. When the contrast reaches the cavernous portion of the internal carotid artery, there is a blush of contrast into the enlarged cavernous sinus (left and middle images). The blood then drains through dilated veins into the internal jugular vein (right image).

A carotid-cavernous fistula is an abnormal communication between the internal carotid artery and the cavernous sinus (venous circulation). They most commonly occur secondary to trauma when the internal carotid artery is torn. In this case, the likely cause of the carotid-cavernous sinus fistula was tearing of the internal carotid artery by shrapnel when the patient was hit in the face by buckshot. Recall that the internal carotid artery passes through the cavernous sinus, and thus their close proximity.

Revised 11/30/06.
Copyrighted 2006. David C Preston