E2643. Asymptomatic Superior Ophthalmic Vein Dilatation is Common and Benign in Adult Patients with Trauma
  1. Joshua Schoen; University of North Carolina Hospitals
  2. Sheng-Che Hung; University of North Carolina Hospitals
Dilated superior ophthalmic vein (SOV) is an uncommon radiographic finding after head injury and is believed to be a warning sign associated with severe intracranial conditions, such as increased intracranial pressure, carotid-cavernous sinus fistula, or cavernous sinus thrombosis, which require additional vascular imaging work-up. However, the incidence and clinical implication of asymptomatic SOV dilatation in patients with trauma remains elusive. This study is aimed to investigate the prevalence and outcome of asymptomatic SOV dilatation in adult patients with trauma, as well as to identify the factors that can predict the outcome of SOV dilatation.

Materials and Methods:
Consecutive adult head CT studies performed for trauma indications between January and September 2020 at one Level 1 trauma center were included and patients with a second follow-up head or maxillofacial CT imaging performed more than one week apart were reviewed. Bilateral SOV diameters were measured and patients were sorted into dilated (one or both SOV diameters = 2.5 mm) and non-dilated groups. SOV diameters were measured on follow-up imaging to evaluate for resolution or persistence of SOV dilatation. Finally, patient imaging reports and medical records were reviewed for the following parameters: body mass index (BMI), gender, laterality of SOV dilatation, intracranial hemorrhage, skull base fracture, intracranial mass, presence of endotracheal tube/ tracheostomy, chronic obstructive pulmonary disease, and presence of acute chest trauma.

Of the 2276 head CTs initially included, 291 of these individuals had a follow-up CT imaging more than 1 week apart (mean interval between two CTs, 63.7 d; range, 5 - 322 d). 28.2% (82/291) of these individuals had unilateral or bilateral dilated SOVs on initial imaging. On follow-up imaging, none of the 82 patients with SOV dilatation on initial imaging were diagnosed of carotico-cavernous sinus fistula or cavernous sinus thrombosis, 38 of 82 (46.3%) had spontaneous resolution of SOV dilatation. There are no significant factors that can differentiate groups with reversible and persistent SOV dilatation.

Asymptomatic SOV dilatation in the trauma population is common with a high percentage of spontaneous resolution. These findings imply that routine emergent vascular imaging evaluation for asymptomatic SOV dilatation may not be necessary in adults with trauma.