Applied Radiology

Diagnosis

Cavernous hemangioma

Findings

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 heterogeneously.

Discussion

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 is curative.

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