Ballistic trauma resulting in carotid-cavernous fistula

Post-traumatic carotid-cavernous fistula is an abnormal communication between the internal carotid artery in its intracavernous portion and the cavernous sinus, resulting from a tear in the arterial wall connecting the internal carotid artery with the cavernous sinus. Direct gunshot trauma is unusual. Clinically, the symptoms most often include a classic triad: red eye, chemosis and proptosis. Cross-sectional imaging including CT angiography allows for positive diagnosis by showing pathognomonic signs. Arteriography remains the procedure of choice for proper mapping of the lesion and accurate specification of the type of fistula, and at the same time serves as a means of embolization. (C) 2012 Elsevier Masson SAS. All rights reserved.