Varix of a Vortex Vein Ampulla Induced by Nodular Scleritis

Cabral, Diogo; Nogueira, Vanda

doi:10.1097/icb.0000000000000968

RETINAL Cases &Amp; Brief Reports

2020

DOI: 10.1097/icb.0000000000000968

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Varix of a Vortex Vein Ampulla Induced by Nodular Scleritis

Diogo Cabral

Vanda Nogueira

Abstract: Choroidal mass lesions instigate a puzzling differential diagnosis. We report the association of two rare causes of choroidal mass lesions: nodular scleritis and vortex vein ampulla varix. Multimodal imaging was used to illustrate how venous outflow obstruction can play a role in the origin of vortex vein varix.

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Cited by 2 publications

References 8 publications

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Acute spontaneous vortex vein occlusion: clinical features, multimodal imaging and natural course

Xue,

Meng,

Ren

et al. 2024

Br J Ophthalmol

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AimsTo describe the clinical features, multimodal imaging, treatments and natural course of acute spontaneous vortex vein occlusion.MethodsClinical data were collected on nine patients with acute vortex vein occlusion. The symptoms and signs, multimodal imaging, treatments and follow-up results were summarised.ResultsSix patients (66.7%) were men and three (33.3%) were women. The mean age was 47.8±15.4 years. Patients were initially misdiagnosed as having choroidal tumour (66.7%), scleritis (22.2%) and peripheral exudative haemorrhagic chorioretinopathy (11.1%). The related clinical characteristics included choroidal pseudo-tumour (100%), anterior segment injection (88.9%), acute ocular pain (77.8%), transient blurred vision (66.7%) and subsequent scleral icterus (66.7%). Six patients (66.7%) experienced a definite Valsalva manoeuvre prior to the onset. In acute phase, ultrasonography showed a low-to-medium reflective lesion without inside blood flow signal (mean thickness, 2.7±0.6 mm). Swept-source optical coherence tomography angiography (SS-OCTA) demonstrated the dilated vortex veins and ampulla with suprachoroidal haemorrhage and exudation. Indocyanine green angiography (ICGA) demonstrated choroidal circulation abnormalities in the affected quadrant. MRI showed a well-defined mass with enhancement. The main treatment was medical observation (44.5%). The choroidal pseudo-tumour spontaneously resolved with a mean course of 4.1±1.9 weeks.ConclusionsAcute vortex vein occlusion is a rare condition and initial misdiagnosis is not uncommon. It is mainly identified as an evanescent choroidal pseudo-tumour with acute pain, red eye and blurred vision. Widefield ICGA and SS-OCTA can offer valuable diagnostic clues. Medical observation may be a treatment option.

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Acute spontaneous vortex vein occlusion: clinical features, multimodal imaging and natural course

Xue,

Meng,

Ren

et al. 2024

Br J Ophthalmol

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The spontaneous resolution of a vortex vein varix: case report

Weidmayer

Demirci

2021

BMC Ophthalmol

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Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

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Varix of a Vortex Vein Ampulla Induced by Nodular Scleritis

Cited by 2 publications

References 8 publications

Acute spontaneous vortex vein occlusion: clinical features, multimodal imaging and natural course

Acute spontaneous vortex vein occlusion: clinical features, multimodal imaging and natural course

The spontaneous resolution of a vortex vein varix: case report

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