Bilateral corkscrew episcleral veins from tricuspid incompetence.

Abstract

To use color Doppler imaging in examining a patient with clinically diagnosed low-flow carotid-cavernous sinus fistula and a history of rheumatic heart disease. The flow characteristics of the orbital vessels and the internal jugular veins were studied with a 7.0-MHz transducer. Episodic arterialization and reversal of blood flow was demonstrated in both superior ophthalmic veins. This similar waveform was also seen in both jugular veins. The presence of tricuspid regurgitation and pulmonary hypertension caused increased episcleral venous pressure and the corkscrew appearance, which is more commonly associated with carotid-cavernous sinus fistula.