Disorders of the Angular Vein

Abstract

Purpose: The angular vein extends between the supraorbital and supratrochlear veins superiorly and the facial vein inferiorly. Rarely, this vessel can be involved by infections, vascular malformations, or benign tumors. In this study, we report both our experience and the published literature on angular vein disorders. Methods: A retrospective study was performed on patients seen between 2008 and 2022. The medical literature was searched for reports of conditions affecting the angular vein. Results: During the study period, we encountered 5 patients with angular vein disorders. Information from these patients was combined with 18 published cases. Among the 23 patients, the diagnosis was confused with lacrimal drainage abnormalities in 52%, and 57% underwent imaging. “Swelling” or a palpable, moveable mass were frequent findings. Pain or tenderness was experienced by 43.5% of patients. Five patients were observed, and 2 infections were treated with antibiotics. The remaining 16 lesions were successfully treated with excision (n = 15) or cauterization (n = 1), without complications. Final diagnosis included 14 vascular malformations (isolated varix: 7, thrombosis: 6, cavernous venous malformation: 1), 7 vascular tumors (intravenous pyogenic granulomas: 6, intravascular papillary endothelial hyperplasia: 1) and thrombophlebitis (n = 2). Conclusions: Disorders of the angular vein are uncommon and frequently misdiagnosed as lacrimal abnormalities. While these lesions can frequently be identified on clinical findings, imaging can be helpful in some cases. Patients with suspected thrombophlebitis require urgent antibiotic therapy. Minimally symptomatic angular vein lesions can be observed. Surgical excision is effective in treating the different vascular malformations and tumors affecting this structure.

A Case of Atraumatic Angular Vein Thrombosis

“…Thrombophlebitis exhibits localized signs [15], such as orbital swelling, maxillary tenderness, and erythema, whereas Lemierre's syndrome is an infectious thrombophlebitis that involves the internal jugular vein with a respiratory infection origin [12]. Angular vein thrombosis, centered around the eye, brings forth aesthetic concerns and potential vision changes [1].…”

“…Angular vein thrombosis is a rare disorder characterized by the formation of a blood clot in the angular vein [1]. The angular vein is located on the side of the root of the nose and is formed superiorly by the supraorbital and supratrochlear veins [2,3].…”

“…Pathologies of the angular vein are rare and therefore can often be misdiagnosed as abnormalities of surrounding structures, such as the nasolacrimal system [5]. Identifying the disorder when it is presented is crucial to prevent complications of worsening obstruction of facial venous circulation and potential clot migration to the cavernous sinus [1].…”

“…Common patient histories note previous surgeries near the area and nasolabial fillers. It is essential to differentiate between other disorders with similar clinical features, such as thrombophlebitis, pyogenic granulomas, and nasolacrimal obstruction [1,11]. Further, Lemierre's syndrome has been reported to cause facial vein thrombosis and should be ruled out when diagnosing angular vein thrombosis [9,12].…”

“…Considering angular vein thrombosis when evaluating patients with angular vein pathologies is essential. With less than 10 total cases reported in the literature [1,5,11,13], there is a paucity of and a need for prior research to learn more about the condition of angular vein thrombosis. Here, we report a unique patient presentation of angular vein thrombosis.…”