Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Houman Sotoudeh; Omid Shafaat; Noha Aboueldahab; Michael Vaphiades; Ehsan Sotoudeh; Joshua Bernstock

doi:10.1016/j.ejro.2019.07.002

Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Eur J Radiol Open. 2019 Jul 11:6:258-264. doi: 10.1016/j.ejro.2019.07.002. eCollection 2019.

Authors

Houman Sotoudeh¹, Omid Shafaat², Noha Aboueldahab³, Michael Vaphiades⁴, Ehsan Sotoudeh⁵, Joshua Bernstock⁶

Affiliations

¹ Department of Neuroradiology, University of Alabama at Birmingham (UAB), 619 19th St S, Birmingham, AL, 35294, JTN 333, USA.
² Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, 8174675731 Alzahra Teaching Hospital, Sofeh Blvd, Isfahan, Iran.
³ Department of Neuroradiology, University of Alabama at Birmingham (UAB), 619 19th St S, Birmingham, AL 35294, USA.
⁴ University of Alabama Birmingham (UAB) Department of Ophthalmology, 700 South 18th Street, Birmingham, AL 35233, USA.
⁵ Department of Surgery, Iranian Hospital in Dubai, P.O.BOX: 2330, Al-Wasl Road, Dubai 2330, United Arab Emirates.
⁶ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building, 60 Fenwood Road, Boston, MA 02115, USA.

Abstract

Purpose: Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis.

Methods: We reviewed the patients' data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome.

Results: Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST.

Conclusions: The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening.

Keywords: B/L, bilateral; CCF, carotid cavernous fistula; CST, cavernous sinus thrombosis; CT, computed tomography; Cavernous sinus thrombosis; F, female; IRB, institutional review board; L, left; M, male; MRI, magnetic resonance Imaging; N/A, not applicable; Orbital cellulitis; R, right; RA, rheumatoid arthritis; SCC, Squamous Cell Carcinoma; SLE, systemic lupus erythematosus; SOV, superior ophthalmic vein; SOVT, superior ophthalmic vein thrombosis; Sinusitis; Superior ophthalmic vein thrombosis; Thrombophlebitis; UTI, Urinary Tract Infection; Y, yes.