The Case of Loretta Hotblood Endocrine Ophthalmopathy

Retrobulbar Muscles Enlarged
Fig. 13.17 This MRI sequence with enhancement of the orbital fat depicts a coronal image directly posterior to the eyeball.

saved a ship and its rebellious crew by taking over command during a storm. The ship suffered a leak, the pumps broke down, and the crew attempted to abandon ship. Graves destroyed the only lifeboat with an axe and repaired the pumps with leather from his own shoes, and all aboard survived. No doubt you know institutions that could do with formidable men like that today.

Carotidocavernous fistula: An exophthalmos may also be caused by a carotidocavernous fistula (Fig. 13.19a). This

Retrobulbar Muscles Enlarged
Fig.13.18 The coronal T1-weighted MR image through the orbit demonstrates very well the centrally located optic nerve and the enlarged ocular muscles on the left—a typical finding in endocrine ophthalmopathy.

entity is a posttraumatic or an idiopathic communication between the carotid artery and the venous cavernous sinus that may have a direct mass effect on the retrobulbar orbit and cause locoregional venous hypertension. Prominent filling of the conjunctival vessels and a vascular bruit detectable by auscultation with a stethoscope are patho-gnomonic. Interventional radiologists have the opportunity to solve this problem with bravery. After documen-

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