Authors:
Máté Magyar Department of Neuroradiology, Faculty of Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary

Search for other papers by Máté Magyar in
Current site
Google Scholar
PubMed
Close
,
Péter Barsi Department of Neuroradiology, Faculty of Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary

Search for other papers by Péter Barsi in
Current site
Google Scholar
PubMed
Close
,
Katalin Korányi Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary

Search for other papers by Katalin Korányi in
Current site
Google Scholar
PubMed
Close
, and
Pál Novák Kaposi Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary

Search for other papers by Pál Novák Kaposi in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-7150-3495
Open access

Abstract

Orbital varices are abnormally enlarged, thin walled veins in direct connection with normal orbital vessels. Stooping, bending, coughing or straining increase the venous tension and in this way can cause symptoms, such as bulging of the eyes (proptosis), orbital pain, bleeding, intermittent double vision. Small varices are managed by observation while larger lesions may require surgery. In our case report we demonstrate the case of a 72-year-old female patient with right sided retro-orbital pressure sensation for weeks, and exophthalmos with blurred vision for 1 week. MR investigation proved the presence of a partially thrombosed orbital varix on the right side, and a smaller, non-thrombosed varix on the left side. Observation was agreed, and the symptoms resolved spontaneously after several weeks.

Abstract

Orbital varices are abnormally enlarged, thin walled veins in direct connection with normal orbital vessels. Stooping, bending, coughing or straining increase the venous tension and in this way can cause symptoms, such as bulging of the eyes (proptosis), orbital pain, bleeding, intermittent double vision. Small varices are managed by observation while larger lesions may require surgery. In our case report we demonstrate the case of a 72-year-old female patient with right sided retro-orbital pressure sensation for weeks, and exophthalmos with blurred vision for 1 week. MR investigation proved the presence of a partially thrombosed orbital varix on the right side, and a smaller, non-thrombosed varix on the left side. Observation was agreed, and the symptoms resolved spontaneously after several weeks.

Introduction

Orbital varix is a rare entity that occurs equally in males and females, typically in the 2nd or 3rd decade of life [1]. It results from the congenital weakness of the postcapillary venous wall [2]. The weakness leads to the proliferation and dramatic dilation of these valveless, thin walled orbital veins. Presenting symptoms of the venous tension and the conflict of vascular formations with oculomotor muscles can include intermittent diplopia, proptosis, decreased visual acuity, and retro-orbital pain [2–4]. A lot of conditions, which increase the venous tension (forward bending, coughing, breath holding, Valsalva maneuver) can cause dramatic protrusion of the affected eye, called unilateral stress proptosis [5]. In some cases orbital varices can manifest with thrombosis and hemorrhage, producing a more sustained, severe proptosis and in rare cases optic nerve injury with consequential visual impairment [6].

Case report

A 72-year-old female patient was referred to the Department of Ophthalmology, with several weeks’ history of right retro-orbital pressure during forward bending. She did not have any previous illnesses, only presbyopia. Physical examination was normal, there was no exophthalmos, her best corrected visual acuity was full on both sides, visual fields were intact, pupillary responses were equal and fundoscopy was unremarkable. Eye movements were in normal range, intraocular pressure was also normal according to Goldmann tonometry. The patient was released and further investigations were planned. After a week the patient felt swelling of the right upper eyelid, pain in the forehead, and blurring of the vision of the right eye. At the Department of Ophthalmology exophthalmos (3 mm), periorbital edema and hyperemia were found on the right side.

The ophthalmologist requested an orbital MR investigation with contrast material (Philips Ingenia 1.5 T, contrast material: Gadovist 7 mL), which revealed a right-sided intraconal thrombosed varix (20 × 17 × 10 mm) displacing the optic nerve, but the thickness and signal intensity of the nerve were normal (Figs. 1 and 2). The left-sided superior orbital vein was also mildly dilatated (3–4 mm). There were no abnormal enhancing mass lesions within the orbits or brain parenchyma. No intracranial arteriovenous malformations, dural fistulas, or carotid cavernous fistulas were identified. Targeted orbital color Doppler investigation on the right side found a hypoechoic retrobulbar lesion without flow signal which mildly displaced the optic nerve.

Figure 1.
Figure 1.

T1-weighted High Resolution Isotropic Volume Examination (THRIVE) without contrast (A) and with contrast (B). Arrow with continuous line: intact optic nerve; Arrow with dotted line: superior ophthalmic vein on the left side; Arrow with dotted stem: orbital varix

Citation: Imaging 12, 1; 10.1556/1647.2020.00001

Figure 2.
Figure 2.

T2-weighted images without abnormal signal intensity of the optic nerve. Arrow with continuous line: optic nerve; Arrow with dotted line: superior ophthalmic vein on the left side; Arrow with dotted stem: varix

Citation: Imaging 12, 1; 10.1556/1647.2020.00001

Two weeks later the symptoms of the patient resolved spontaneously. The control ophtalmogical investigation was normal, no exophthalmos, periorbital edema, or hyperemia was found.

Discussion

The best diagnostic tool for orbital varices is magnetic resonance imaging. Orbital varices have hypo-to hyperintense signal on T1-weighted images, hyperintense signal on T2-weighted images, and usually enhance intensely after the administration of contrast material. The post-contrast sequences are also essential to prove thromboembolic complications [7]. Other causes or orbital masses, such as cavernous hemangiomas and lymphangioma should be included in the differential diagnosis of orbital varices [7].

In our case MRI demonstrated a tortuous, partially thrombosed – can explain why flow signal cannot be detected with color Doppler investigation – dilatated intraconal vessel in the posterior orbit, which tapered toward the orbital apex and lacked internal septae. Imaging did not reveal orbital wall defect.

Observation was agreed, and the symptoms of the patient resolved spontaneously.

There are no well established guidelines for treatment. Small lesions do not usually require treatment, but observation. Recurrent thrombosis, pain, severe proptosis, or compression of the optic nerve require intervention, for example electrothrombosis [8], stereotactic gamma knife radiosurgery [9], sclerotherapy, endovascular embolization with or without surgical excision. The long-term risk of missed treatment are optic nerve atrophy and blindness [3, 8, 10].

Funding sources

No financial support was received for this case report.

Authors’ contribution

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, writing, or revision of the manuscript. Acquisition of images: PB, PKN, MM. Analysis and/or interpretation of literature: PB, PKN, MM. Drafting the manuscript: MM. Revising the manuscript critically for important intellectual content: BP, PKN, KK. Approval of the version of the manuscript to be published: BP, PNK, KK, MM. This manuscript has not been published previously and is not under consideration for publication elsewhere.

Conflict of interests

The authors have no conflict of interest to disclose.

References

  • [1]

    Rubin PAD, Remulla HD: Orbital venous anomalies demonstrated by spiral computed tomography. Ophthalmology 1997; 104(9): 14631470.

  • [2]

    Smoker WR, Gentry LR, Yee NK, Reede DL, Nerad JA: Vascular lesions of the orbit: more than meets the eye. Radiographics 2008; 28(1): 185204.

  • [3]

    Carrim ZI, Ahmed TY, Wykes WN: Isolated superior ophthalmic vein thrombosis with orbital congestion: a variant of idiopathic orbital inflammatory disease? Eye (Lond). England 2007; 21(5): 665666.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [4]

    Vadlamudi V, Gemmete JJ, Chaudhary N, Pandey AS, Kahana A: Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin. BMJ Case Rep 2015.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [5]

    Cohen JA, Char DH, Norman D: Bilateral orbital varices associated with habitual bending. Arch Ophthalmol 1995; 113(11): 13601362.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [6]

    Phan IT, Hoyt WF, McCulley TJ, Hwang TN: Blindness from orbital varices: case report. Orbit 2009; 28(5): 303305.

  • [7]

    Heran F, Berges O, Blustajn J, Boucenna M, Charbonneau F, Koskas P: Tumor pathology of the orbit. Diagn Interv Imaging 2014; 95(10): 933944.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [8]

    Tsai AS, Fong KS, Lim W, Al Jajeh I, Chuah CT, Rootman J: Bilateral orbital varices: an approach to management. Ophthalmic Plast Reconstr Surg 2008; 24(6): 486488.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [9]

    Xu D, Liu D, Zhang Z, Zhang Y, Song G: Gamma knife radiosurgery for primary orbital varices: a preliminary report. Br J Ophthalmol 2011; 95(9): 12641267.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [10]

    Kumar RR, Singh A, Abhishek: Embolization of a deep orbital varix through endovascular route. Indian J Ophthalmol 2015; 63(3): 270272.

  • [1]

    Rubin PAD, Remulla HD: Orbital venous anomalies demonstrated by spiral computed tomography. Ophthalmology 1997; 104(9): 14631470.

  • [2]

    Smoker WR, Gentry LR, Yee NK, Reede DL, Nerad JA: Vascular lesions of the orbit: more than meets the eye. Radiographics 2008; 28(1): 185204.

  • [3]

    Carrim ZI, Ahmed TY, Wykes WN: Isolated superior ophthalmic vein thrombosis with orbital congestion: a variant of idiopathic orbital inflammatory disease? Eye (Lond). England 2007; 21(5): 665666.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [4]

    Vadlamudi V, Gemmete JJ, Chaudhary N, Pandey AS, Kahana A: Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin. BMJ Case Rep 2015.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [5]

    Cohen JA, Char DH, Norman D: Bilateral orbital varices associated with habitual bending. Arch Ophthalmol 1995; 113(11): 13601362.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [6]

    Phan IT, Hoyt WF, McCulley TJ, Hwang TN: Blindness from orbital varices: case report. Orbit 2009; 28(5): 303305.

  • [7]

    Heran F, Berges O, Blustajn J, Boucenna M, Charbonneau F, Koskas P: Tumor pathology of the orbit. Diagn Interv Imaging 2014; 95(10): 933944.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [8]

    Tsai AS, Fong KS, Lim W, Al Jajeh I, Chuah CT, Rootman J: Bilateral orbital varices: an approach to management. Ophthalmic Plast Reconstr Surg 2008; 24(6): 486488.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [9]

    Xu D, Liu D, Zhang Z, Zhang Y, Song G: Gamma knife radiosurgery for primary orbital varices: a preliminary report. Br J Ophthalmol 2011; 95(9): 12641267.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • [10]

    Kumar RR, Singh A, Abhishek: Embolization of a deep orbital varix through endovascular route. Indian J Ophthalmol 2015; 63(3): 270272.

  • Collapse
  • Expand

 

The author instruction is available in PDF.
Please, download the file from HERE.
 
The Open Access statement together with the description of the Copyright and License Policy are available in PDF.
Please, download the file from HERE.


 

Chair of the Editorial Board:
Béla MERKELY (Semmelweis University, Budapest, Hungary)

Editor-in-Chief:
Pál MAUROVICH-HORVAT (Semmelweis University, Budapest, Hungary)

Deputy Editor-in-Chief:
Viktor BÉRCZI (Semmelweis University, Budapest, Hungary)

Executive Editor:
Charles S. WHITE (University of Maryland, USA)

Deputy Editors:
Gianluca PONTONE (Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy)
Michelle WILLIAMS (University of Edinburgh, UK)

Senior Associate Editors:
Tamás Zsigmond KINCSES (University of Szeged, Hungary)
Hildo LAMB (Leiden University, The Netherlands)
Denisa MURARU (Istituto Auxologico Italiano, IRCCS, Milan, Italy)
Ronak RAJANI (Guy’s and St Thomas’ NHS Foundation Trust, London, UK)

Associate Editors:
Andrea BAGGIANO (Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy)
Fabian BAMBERG (Department of Radiology, University Hospital Freiburg, Germany)
Péter BARSI (Semmelweis University, Budapest, Hungary)
Theodora BENEDEK (University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania)
Ronny BÜCHEL (University Hospital Zürich, Switzerland)
Filippo CADEMARTIRI (SDN IRCCS, Naples, Italy) Matteo CAMELI (University of Siena, Italy)
Csilla CELENG (University of Utrecht, The Netherlands)
Edit DÓSA (Semmelweis University, Budapest, Hungary)
Marco FRANCONE (La Sapienza University of Rome, Italy)
Viktor GÁL (OrthoPred Ltd., Győr, Hungary)
Alessia GIMELLI (Fondazione Toscana Gabriele Monasterio, Pisa, Italy)
Tamás GYÖRKE (Semmelweis Unversity, Budapest)
Fabian HYAFIL (European Hospital Georges Pompidou, Paris, France)
György JERMENDY (Bajcsy-Zsilinszky Hospital, Budapest, Hungary)
Pál KAPOSI (Semmelweis University, Budapest, Hungary)
Mihaly KÁROLYI (University of Zürich, Switzerland)
Lajos KOZÁK (Semmelweis University, Budapest, Hungary)
Mariusz KRUK (Institute of Cardiology, Warsaw, Poland)
Zsuzsa LÉNARD (Semmelweis University, Budapest, Hungary)
Erica MAFFEI (ASUR Marche, Urbino, Marche, Italy)
Robert MANKA (University Hospital, Zürich, Switzerland)
Saima MUSHTAQ (Cardiology Center Monzino (IRCCS), Milan, Italy)
Gábor RUDAS (Semmelweis University, Budapest, Hungary)
Balázs RUZSICS (Royal Liverpool and Broadgreen University Hospital, UK)
Christopher L SCHLETT (Unievrsity Hospital Freiburg, Germany)
Bálint SZILVESZTER (Semmelweis University, Budapest, Hungary)
Richard TAKX (University Medical Centre, Utrecht, The Netherlands)
Ádám TÁRNOKI (National Institute of Oncology, Budapest, Hungary)
Dávid TÁRNOKI (National Institute of Oncology, Budapest, Hungary)
Ákos VARGA-SZEMES (Medical University of South Carolina, USA)
Hajnalka VÁGÓ (Semmelweis University, Budapest, Hungary)
Jiayin ZHANG (Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China)

International Editorial Board:

Gergely ÁGOSTON (University of Szeged, Hungary)
Anna BARITUSSIO (University of Padova, Italy)
Bostjan BERLOT (University Medical Centre, Ljubljana, Slovenia)
Edoardo CONTE (Centro Cardiologico Monzino IRCCS, Milan)
Réka FALUDI (University of Szeged, Hungary)
Andrea Igoren GUARICCI (University of Bari, Italy)
Marco GUGLIELMO (Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy)
Kristóf HISRCHBERG (University of Heidelberg, Germany)
Dénes HORVÁTHY (Semmelweis University, Budapest, Hungary)
Julia KARADY (Harvard Unversity, MA, USA)
Attila KOVÁCS (Semmelweis University, Budapest, Hungary)
Riccardo LIGA (Cardiothoracic and Vascular Department, Università di Pisa, Pisa, Italy)
Máté MAGYAR (Semmelweis University, Budapest, Hungary)
Giuseppe MUSCOGIURI (Centro Cardiologico Monzino IRCCS, Milan, Italy)
Anikó I NAGY (Semmelweis University, Budapest, Hungary)
Liliána SZABÓ (Semmelweis University, Budapest, Hungary)
Özge TOK (Memorial Bahcelievler Hospital, Istanbul, Turkey)
Márton TOKODI (Semmelweis University, Budapest, Hungary)

Managing Editor:
Anikó HEGEDÜS (Semmelweis University, Budapest, Hungary)

Pál Maurovich-Horvat, MD, PhD, MPH, Editor-in-Chief

Semmelweis University, Medical Imaging Centre
2 Korányi Sándor utca, Budapest, H-1083, Hungary
Tel: +36-20-663-2485
E-mail: maurovich-horvat.pal@med.semmelweis-univ.hu

Indexing and Abstracting Services:

  • WoS Emerging Science Citation Index
  • Scopus
  • DOAJ

2022  
Web of Science  
Total Cites
WoS
65
Journal Impact Factor 0.4
Rank by Impact Factor

n/a

Impact Factor
without
Journal Self Cites
0.3
5 Year
Impact Factor
0.8
Journal Citation Indicator 0.06
Rank by Journal Citation Indicator

Medicine, General & Internal (Q4)

Scimago  
Scimago
H-index
18
Scimago
Journal Rank
0.171
Scimago Quartile Score

Medicine (miscellanous) (Q4)
Radiological and Ultrasound Technology (Q4)
Radiology, Nuclear Medicine and Imaging (Q4)

Scopus  
Scopus
Cite Score
1.0
Scopus
CIte Score Rank
Medicine (miscellaneous) 221/309 (28th PCTL)
Radiological and Ultrasound Technology 45/58 (23rd PCTL)
Radiology, Nuclear Medicine and Imaging 242/312 (22nd PCTL)
Scopus
SNIP
0.354

2021  
Web of Science  
Total Cites
WoS
56
Journal Impact Factor not applicable
Rank by Impact Factor

not applicable

Impact Factor
without
Journal Self Cites
not applicable
5 Year
Impact Factor
not applicable
Journal Citation Indicator 0,10
Rank by Journal Citation Indicator

Medicine, General & Internal 236/329

Scimago  
Scimago
H-index
16
Scimago
Journal Rank
0,226
Scimago Quartile Score Medicine (miscellaneous) (Q4)
Radiological and Ultrasound Technology (Q4)
Radiology, Nuclear Medicine and Imaging (Q4)
Scopus  
Scopus
Cite Score
1,6
Scopus
CIte Score Rank
Medicine (miscellaneous) 175/276 (Q3)
Radiology, Nuclear Medicine and Imaging 209/308 (Q3)
Radiological and Ultrasound Technology 42/60 (Q3)
Scopus
SNIP
0,451

2020  
CrossRef Documents 7
CrossRef Cites 0
CrossRef H-index 1
Days from submission to acceptance 17
Days from acceptance to publication 70
Acceptance Rate 43%

Imaging
Publication Model Gold Open Access
Submission Fee none
Article Processing Charge none
Subscription Information Gold Open Access

Imaging
Language English
Size A4
Year of
Foundation
2020 (2009)
Volumes
per Year
1
Issues
per Year
2
Founder Akadémiai Kiadó
Founder's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2732-0960 (Online)

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Apr 2023 0 48 35
May 2023 0 41 30
Jun 2023 0 35 35
Jul 2023 0 26 28
Aug 2023 0 27 23
Sep 2023 0 42 27
Oct 2023 0 0 0