Presentation
Acute onset of left orbital pain with proptosis.
Patient Data
The MRI sequences demonstrate:
- left orbital ovoid mass of intraconal location displacing the optic nerve inferomedially and the ocular globe anteriorly with proptosis grade 3. It measures 30 x 20 x 17 mm and elicits a high signal on T1, low signal on T2, T2 GE and FLAIR centrally with low signal on T1 high signal FLAIR and T2 peripherally with no enhancement on postcontrast sequences in keeping with hematoma
- poorly marginated, non-encapsulated left superomedial orbital mass of extraconal location with intraconal extension measuring 28 x 20x 18 mm of low signal on T1 high signal T2 and FLAIR containing foci of low signal T2 (phleboliths) with fluid-fluid levels well-demonstrated on axial and coronal T2 fat sat sequences, corresponding to hemorrhagic, lymphatic, or proteinaceous content within the cystic spaces. The postcontrast sequences show a heterogeneous enhancement.
Small vessel ischemic changes are noted.
Follow-up MRI performed 1 month later demonstrates complete regression of the orbital hematoma as well the mass effect on the orbital structures.
The left superomedial orbital mass shows the same features as compared with the 1st MRI exam.
Case Discussion
The MRI features are suggestive of spontaneous bleeding from an orbital lymphangioma, completely resolved following medical treatment.
Orbital lymphangiomas, also known as orbital venous lymphatic malformations, are congenital benign orbital vascular malformations composed of variable venous and lymphatic components.
The spontaneous orbital bleeding may cause acute proptosis as well as compression of the optic nerve, and vision loss 1.
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