Anomalous intracranial venous drainage mimicking orbital or cavernous arteriovenous fistula

A 9-year-old child presented with right eye swelling and bluish discoloration over the periorbital region. MR and CT displayed prominent vessels within the orbit and in the facial region, suggesting a carotid-cavernous fistula. Doppler ultrasound indicated the vascular engorgement was not secondary to a proximal arteriovenous shunt. Arteriography with its inherent time sequence image capability prompted the proper diagnosis of bilateral atresia of the sigmoid sinuses.