Answer for CoW 14 Jan 2018
Left intraconal hemangioma
Findings
Well defined T1 isointense lesion of size 2(AP)X1.6(T)X1.7(CC)cm noted in the intraconal compartment of left orbit displaces the optic nerve medially. On contrast shows enhancement.
Discussion
Cavernous venous malformations of the orbit, also known as cavernous haemangiomas, are the most common vascular lesion of the orbit in adults. 5-7% of all orbital tumours. They usually present in middle age (30-50 years of age) and there appears to be a female predilection Clinical presentation is usually with a slowly growing orbital mass resulting in proptosis. Diplopia and visual field defects (from optic nerve compression) may also occur. Although cavernous haemangiomas can be located anywhere within the orbit over 80% are located within the intraconal compartment, most commonly in the lateral aspect. They are usually round or oval in cross section and although frequently abut the globe, they do no deform it, but rather are deformed by the globe, on account of their soft consistency. Large lesions may be associated with expansion of the bony confines of the orbit. Ultrasound demonstrates a smoothly circumscribed retrobulbar lesion with regular moderate to high internal echogenicity. No flow can be demonstrated on Doppler scanning CT Cavernous haemangioma appears as a well circumscribed, rounded or oval soft tissue density mass. The orbital apex is usually spared. Sclerosing haemangiomas sometimes demonstrate calcification. MRI Appearance on MRI is the same morphologically as on CT, with the following signal intensities: T1 isointense compared to muscle if areas of thrombosis are present, then hyperintense regions may be visible. T2 hyperintense compared to muscle may have low-intensity septation pseudocapsule is of low intensity T1 C+ (Gd): slow gradual irregular enhancement with delayed wash out DSA Angiographically haemangiomas are occult as enhancement occurs only in a delayed fashion. more common intra-conal variety the differential includes : optic nerve meningioma orbital schwannoma haemangiopericytoma sclerosing haemangioma (a variant rather than a distinct entity) orbital metastases orbital fibrous histiocytoma orbital lymphoma orbital venous varix capillary haemangioma of orbit.
Findings
Well defined T1 isointense lesion of size 2(AP)X1.6(T)X1.7(CC)cm noted in the intraconal compartment of left orbit displaces the optic nerve medially. On contrast shows enhancement.
Discussion
Cavernous venous malformations of the orbit, also known as cavernous haemangiomas, are the most common vascular lesion of the orbit in adults. 5-7% of all orbital tumours. They usually present in middle age (30-50 years of age) and there appears to be a female predilection Clinical presentation is usually with a slowly growing orbital mass resulting in proptosis. Diplopia and visual field defects (from optic nerve compression) may also occur. Although cavernous haemangiomas can be located anywhere within the orbit over 80% are located within the intraconal compartment, most commonly in the lateral aspect. They are usually round or oval in cross section and although frequently abut the globe, they do no deform it, but rather are deformed by the globe, on account of their soft consistency. Large lesions may be associated with expansion of the bony confines of the orbit. Ultrasound demonstrates a smoothly circumscribed retrobulbar lesion with regular moderate to high internal echogenicity. No flow can be demonstrated on Doppler scanning CT Cavernous haemangioma appears as a well circumscribed, rounded or oval soft tissue density mass. The orbital apex is usually spared. Sclerosing haemangiomas sometimes demonstrate calcification. MRI Appearance on MRI is the same morphologically as on CT, with the following signal intensities: T1 isointense compared to muscle if areas of thrombosis are present, then hyperintense regions may be visible. T2 hyperintense compared to muscle may have low-intensity septation pseudocapsule is of low intensity T1 C+ (Gd): slow gradual irregular enhancement with delayed wash out DSA Angiographically haemangiomas are occult as enhancement occurs only in a delayed fashion. more common intra-conal variety the differential includes : optic nerve meningioma orbital schwannoma haemangiopericytoma sclerosing haemangioma (a variant rather than a distinct entity) orbital metastases orbital fibrous histiocytoma orbital lymphoma orbital venous varix capillary haemangioma of orbit.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!