A 75 year old woman came to us with a 2 day history of pain in the right temple on combing her hair. On examination, a thin walled, dilated tortuous vessel was seen on the right temple with a tender 20 mm cord along the course of the vessel, under the hairline. She also had enophthalmos and ptosis in the right eye. On questioning, she acknowledged that the tortous vessel had been visible for the last few years. Her ESR was 15 mm/hour. Contrast enhanced computed tomography (CT) of the orbit showed a right orbital venous angioma extending onto the scalp. The acute scalp pain was probably due to thrombosis of the extracranial draining vein.
Neurologists immediately suspect temporal arteritis when elderly patients complain of scalp pain on touch. However, this case demonstrates the unusual occurrence of a temporal phlebitis simulating temporal arteritis.
Figure 1 (A) Clinical picture showing distended and tortuous temporal vein; (B) CT orbit showing venous angioma situated in the right orbit. Informed consent was obtained for publication of this figure.
Footnotes
Competing interests: none declared