Cape Hays T, Gupta Lalita, Blanchard Cody C, Raslau Flavius D, Timoney Peter J
Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Orbit. 2025 Jun;44(3):348-352. doi: 10.1080/01676830.2024.2393416. Epub 2024 Aug 28.
A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus.
一名66岁有鼻窦炎病史的女性出现持续性复视和眼睑肿胀加重。检查发现双侧视力丧失、颅神经麻痹、左侧结膜水肿、眼球突出和水肿。初始影像学检查显示蝶窦混浊、双侧筛窦病变、双侧海绵窦未充盈以及左眼上静脉部分血栓形成。通过鼻内镜鼻窦手术对鼻窦检查结果进行评估，未发现异常。随后的眼眶影像学检查提示病变符合肿瘤血栓而非单纯血栓。CT扫描显示右腋窝有一个大肿块，经活检确诊为弥漫性大B细胞淋巴瘤（DLBCL）。该患者接受了抗凝、类固醇和化疗治疗，病情明显改善。我们的报告强调了一例罕见的由DLBCL导致的肿瘤血栓引起双侧海绵窦血栓形成的病例，据我们所知，这是首例有文献记载的由肿瘤血栓导致眼上静脉血栓形成的病例。
