An Unusual Presentation of Retrobulbar Cavernous Hemangioma in a Young Woman.

Khan Shama A Irfan,Barun Kumar,Ramanuj Samanta,Rakesh Panyala,Anupam Singh

doi:10.7759/cureus.17508

Abstract

A 38-year-old woman presented with sudden-onset painful lid swelling, proptosis and external ophthalmoplegia on the right side for 20 days, associated with loss of vision for nine days. On contrast-enhanced computed tomography (CECT), a retrobulbar mass was noted involving intraconal and extraconal spaces, extending up to the orbital foramina with enhancement and thickening of meninges. CT arteriography further revealed multiple feeding vessels from the maxillary artery. Embolization of feeding vessels followed by right orbital exenteration with primary reconstruction using forehead flap was done. This is an unusual case of orbital cavernous hemangioma (OCH) which emphasizes the importance of CT arteriography in specific cases of OCH, where routine neuroimaging may be inconclusive.

Highlights

Orbital cavernous hemangiomas (OCHs) are one of the most common unilateral intraconal benign orbital vascular tumours [1,2,3]
This is an unusual case of orbital cavernous hemangioma (OCH) which emphasizes the importance of CT arteriography in specific cases of OCH, where routine neuroimaging may be inconclusive
We report an unusual acute presentation of an orbital cavernous hemangioma involving both intraconal and extraconal spaces in a young woman, who presented with complete loss of vision

Summary

Introduction

Orbital cavernous hemangiomas (OCHs) are one of the most common unilateral intraconal benign orbital vascular tumours [1,2,3]. We report an unusual acute presentation of an orbital cavernous hemangioma involving both intraconal and extraconal spaces in a young woman, who presented with complete loss of vision. Contrastenhanced computed tomography (CECT) orbits and paranasal sinuses revealed a retrobulbar mass of size 3.5×2.8×2.7 cm with a dense calcific focus, extending to intraconal and extraconal spaces, closely abutting medial wall, and the frontal sinus, infiltrating into the optic nerve laterally and reaching up to the orbital foramina posteriorly (Figure 2, red arrows). Contrast-enhanced magnetic resonance imaging (CE-MRI) orbit and paranasal sinus confirmed the presence of an ill-defined mass involving both intraconal and extraconal spaces. (A-D) Showing an ill-defined mass involving both intraconal and extraconal spaces without any evidence of intracranial extension (yellow arrows). On histopathological examination of the excised mass (Figure 6A), large dilated vascular channels lined by flattened endothelial cells with an intervening fibrous interstitium were seen, suggestive of OCH (Figure 6B-6C, red arrows). The patient was asymptomatic after two years with good cosmesis (Figure 7)

Discussion

Conclusions

Disclosures

Harris GJ