Recurrent Symptoms From Multifocal Cavernous Hemangioma in the Orbit.

Abstract

A 48-year-old woman presented with complaints of pulsating retro-orbital pain and progressive proptosis of her left globe for the past several weeks with a measured difference of 3 mm (Panel A). The patient reported similar symptoms when she was diagnosed with multifocal orbital cavernous hemangioma 9 years prior. The prior lesions were resected with a lateral orbitotomy, and 2 discrete lesions were described. New CT imaging of her orbit (Panel B) revealed multiple, well-defined, slightly heterogenous lesions within the left orbit immediately posterior to the left globe. An additional hyperdense lesion was noted within the left anterior ethmoid air cell. A radiologic diagnosis of recurrent/residual multifocal cavernous hemangioma was made. Our patient underwent simultaneous endoscopic sinus surgery for the ethmoid lesion and an anterior orbitotomy via the transconjunctival lower eyelid approach. Pathology revealed all lesions to be benign cavernous hemangiomas. It is uncertain whether the recurrence of symptoms and proptosis are from prior incomplete resection or new lesions. This case highlights the uncommon finding of multifocal cavernous hemangiomas rather than the usual circumscribed solitary lesion. Her course also highlights the possibility of growth of residual lesions or the development of new lesions when a multifocal disease is present. Future studies could assist in delineating the natural course of these lesions for better prognostic discussion.