Presentation
Progressive painless swelling of the right fronto-orbital region.
Patient Data
There is a poorly marginated, multiloculated right orbital cystic mass of intra-and extraconal location surrounding the optic nerve, extending to the upper and lower eyelids as well as the frontal region with bone remodeling. It elicits an intermediate to high signal on T1, high signal on T2 with multiple cystic spaces with fluid-fluid levels well-visualized mainly on T2 sequences (hemorrhagic, lymphatic, or proteinaceous content). The postcontrast sequences show a heterogeneous enhancement mainly the margins of the cystic spaces. A mass effect is noted on orbital structures mainly of the optic nerve and eye globe which shows a proptosis grade III.
Case Discussion
MRI features most consistent with fronto-orbital lymphatic malformation.
The orbital lymphatic malformation is uncommon and considered as a congenital benign vascular malformation with variable lymphatic and venous components.
It may increase in size progressively, producing proptosis of the affected eye with bone remodeling (as in this case). Hemorrhage within the cystic spaces may be seen after infection or minor trauma. MRI is considered the modality of choice to evaluate this lymphatic malformation and depicts its various components 1.