Post-Traumatic Carotid-Cavernous Fistula in a Child: An Unusual Complication of Craniofacial Injury

Carotid-cavernous fistulas (CCFs) are rare vascular abnormalities in children, especially when occurring as a delayed consequence of trauma. They are defined as arteriovenous shunts caused by an abnormal communication between the intracavernous portion of the internal carotid artery and the cavernous sinus, usually resulting from a tear in the arterial wall. We report the case of a 4-year-old boy who presented with acute unilateral proptosis evolving over 8 days. The clinical history revealed a blunt orbital trauma that had occurred three months earlier following a fall during play. A contrast-enhanced orbital CT scan confirmed the diagnosis of a post-traumatic carotid-cavernous fistula. The patient was successfully treated by endovascular embolization. This case highlights the importance of considering delayed vascular complications in pediatric craniofacial trauma and emphasizes the key role of imaging and interventional radiology in the diagnosis and management of CCFs.