Mao et al reported factors associated with a traumatic carotid-cavernous sinus fistula. Early diagnosis of a fistula is important to reduce morbidity. The authors are from Chang Gung University in Taiwan.

Patient selection: trauma


Examination: non-contrast head CT


Predictors of a traumatic carotid-cavernous sinus fistula:

(1) engorgement of the superior ophthalmic vein (SOV) and cavernous sinus (OR 35.4)

(2) lateral impact (OR 4.0), as indicated by ipsilateral temporal and sphenoid sinus fractures


The superior ophthalmic vein is identified between the superior rectus muscle and the optic nerve. The reference diameter is at the point closest to the posterior pole of the globe in the axial plane.


A superior ophthalmic vein diameter > 4 mm indicates engorgement.



• Engorgement of the superior ophthalmic vein has an area under the ROC curve of 0.89.

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