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Sorry to change the subject but  I just completed an interesting orbital
scan and would like some feedback since I don't really do allot of these.

A patient was referred back to one of our vascular surgeons for recent
symptoms of right amaurosis fugax.   She had a previous carotid scan in
April which revealed bilateral carotid occlusions with a greater than 50%
stenosis of the left external.  The vertebral and subclavian arteries  were
widely patent bilaterally.

He  ordered orbital  imaging of the right ophthalmic artery.  He wanted to
know if this was an embolic phenomenon either from the top of the carotid
artery via the ophthalmic artery or from the collateral circulation formed
by the right external and wanted to know the direction of flow in the
ophthalmic artery.

The ophthalmic flow appeared monophasic with retrograde via collaterals
around the orbit, however the optic sheath which is usually  readily
identified, center and just posterior to the globe appeared to be displaced
quite obviously to the temporal side (versus nasal.)  It also appeared
echogenic,  not anechoic.

My first thoughts were that  a tumor/mass, which I wasn't able to visualize
was displacing the optic sheath.   However I have no literature on this.
Does anyone have information you could share.

Has anyone ever seen this before? Our surgeon will be ordering a CT scan, so
I have no correlation as yet.

Tracking this and another Hurricane!

Joanne Spindel, RDCS, RVT
Vascular Lab Manager
Vascular and Surgery Associated of Sarasota