Infantile hemangioendothelioma of the parotid and orbit

Case contributed by Khalid Alhusseiny


Parents noted swelling of the right cheek that was not evident at birth.

Patient Data

Age: 1 month
Gender: Female

The right parotid gland is diffusely enlarged with rather homogenous echogenicity and markedly increased vascularity on color-flow imaging.

The right parotid gland is diffusely enlarged, displaying almost homogeneous intermediate signal on T1 and T2 WI and avid homogeneous contrast uptake. Multiple small vascular branches are seen related to its medial and superior aspects with multiple blooming artifacts seen within the gland on SWI.

Right orbital extraconal soft tissue lesion is also seen superior and medial to the right eye globe and extending anteriorly elevating the superior eyelid . This lesion displays intermediate to high signal on T2 WI, intermediate signal on T1 WI and diffuse contrast uptake. Small vascular branches are also seen related to its medial aspect. No intraconal or intracranial extension seen.

Case Discussion

Hemangioendothelioma (or hemangioma) of the parotid gland:

  • It is considered the most common parotid gland tumor of childhood.
  • On ultrasonography (US); it is mostly seen as homogeneous mass replacing most of the parotid gland, with numerous large intratumoral vessels.
  • On MRI; it demonstrates uniform contrast enhancement apart from the flow voids.

Benign hemangioendothelioma (or capillary hemangioma) of the orbit:

  • It is the most common orbital vascular tumor in infants. It is an extraconal lesion.
  • On computed tomography (CT); it demonstrates intense homogeneous contrast uptake. CT is the preferred initial modality of imaging as it requires no sedation.
  • On US; it is compressible and hyperechoic.
  • On MRI; it is usually hypointense on T1 WI and iso- to hyperintense on T2 WI with intense contrast uptake. Features supporting diagnosis include lobules with thin septa, as well as intralesional and perilesional flow voids.

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