Engorgement of the Angular and Temporal Veins Following Periorbital Hyaluronic Acid Gel Injection

A Case of Atraumatic Angular Vein Thrombosis

Angular vein thrombosis is a rare vascular disorder marked by the occlusion of the angular vein by a blood clot. We report the case of a 70-year-old woman who presented with a visible bulge near her left nasojugal groove for one week and had no other associated symptoms or pertinent medical history. Subsequent maxillofacial CT scans with contrast revealed left angular vein thrombosis with dilation of the facial vein inferiorly. Despite its rarity, angular vein thrombosis poses a diagnostic challenge due to overlapping symptoms with other vascular and nonvascular pathologies. This case highlights the importance of early identification to prevent complications such as facial venous circulation obstruction and clot migration to the cavernous sinus.

Disorders of the Angular Vein

PURPOSE

The angular vein extends between the supraorbital and supratrochlear veins superiorly and the facial vein inferiorly. Rarely, this vessel can be involved by infections, vascular malformations, or benign tumors. In this study, we report both our experience and the published literature on angular vein disorders.

METHODS

A retrospective study was performed on patients seen between 2008 and 2022. The medical literature was searched for reports of conditions affecting the angular vein.

RESULTS

During the study period, we encountered 5 patients with angular vein disorders. Information from these patients was combined with 18 published cases. Among the 23 patients, the diagnosis was confused with lacrimal drainage abnormalities in 52%, and 57% underwent imaging. "Swelling" or a palpable, moveable mass were frequent findings. Pain or tenderness was experienced by 43.5% of patients. Five patients were observed, and 2 infections were treated with antibiotics. The remaining 16 lesions were successfully treated with excision (n = 15) or cauterization (n = 1), without complications. Final diagnosis included 14 vascular malformations (isolated varix: 7, thrombosis: 6, cavernous venous malformation: 1), 7 vascular tumors (intravenous pyogenic granulomas: 6, intravascular papillary endothelial hyperplasia: 1) and thrombophlebitis (n = 2).

CONCLUSIONS

Disorders of the angular vein are uncommon and frequently misdiagnosed as lacrimal abnormalities. While these lesions can frequently be identified on clinical findings, imaging can be helpful in some cases. Patients with suspected thrombophlebitis require urgent antibiotic therapy. Minimally symptomatic angular vein lesions can be observed. Surgical excision is effective in treating the different vascular malformations and tumors affecting this structure.