Summary: A 64-year-old female with an orbital mass presents with altered mental status.
Axial-noncontrast computed tomography (CT), axial FLAIR,
coronal T1 pre- and postcontrast images are provided. The axial CT image
demonstrates an oval soft tissue density within the intraconal fat of the right
orbit. The magnetic resonance (MR) images demonstrate that the lesion is
intraconal and separate from the rectus muscles and optic nerve. The lesion is
mildly hyperintense on the FLAIR image, hypointense on the T1WI, and enhances
Intraorbital cavernous hemangiomas are the most common
isolated orbital mass in adults. Patients tend to present with progressive
proptosis, diplopia, and visual impairment, although many patients are
asymptomatic with the lesions discovered incidentally. Cavernous hemangiomas
are venous malformations, which are characterized by endothelial-lined
cavernous spaces with a fibrous pseudocapsule. They grow slowly over time and
tend to present between the ages of 30 and 50.
Cavernous hemangiomas are usually diagnosed by CT or MRI.
They may occur anywhere within the orbit, although 80% are intraconal. They are
usually round or oval and very well-defined due to the fibrous pseudocapsule.
As cavernous hemangiomas grow they create mass effect upon the optic nerve as
well as the globe with resultant visual disturbances and proptosis. The lesions
are isointense to the rectus muscles on T1WI and hyperintense on T2WI. Dynamic
imaging after the administration of contrast material demonstrates slow,
gradual irregular enhancement of the lesion.
Treatment depends upon the clinical presentation. Asymptomatic
lesions may be treated conservatively with the understanding that the lesion
will likely grow slowly over time. In symptomatic patients surgical resection
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