Case 7 :  

A 12-year-old female with painless proptosis of 6 months duration.
What is the diagnosis?

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Imaging Findings


MRI findings reveal an intra conal mass with peripheral haemosiderin ring (Fig 1), with T1W image showing hyperintense areas suggestive of blood products (Fig 3).





Cavernous hemangioma is one of the most common benign intra orbital lesions.

Cavernous hemangioma shows a female predominance, occurs most frequently in the third and fourth decades of life.

They are characterized by a slow progressive course.

Symptoms consist of proptosis and deficient extroccular motility.  It is most commonly located within the muscle cone.

Cavernous haemangiomas consists of large dilated endothelium lined vascular channels, they are encompassed by a fibrous pseudocapsule.  The arterial blood supply is not prominent and blood flow is relatively stagnant.  Thus thrombosis is common; spontaneous haemorrhage is not a feature of this lesion.

Imaging studies demonstrate a homogenous mass within the muscle cone with smooth margins and generally uniform contrast enhancement.

On MR T1 weighted images it is isointense to muscle and hyperintense on T2 weighted images.  They usually do not deform the globe which abutting it, distinguishing hemangioma from many retrobulbar metastases.  Expansion of adjacent orbital wall is common, but bone destruction does not occur and if present suggests a more aggressive lesion.  These tumors show no tendency to recur or undergo malignant transformation.  It is important to differentiate haemangioma from lymphangioma of the orbit, a lesion that is not easily removed surgically, frequently recurs, and is more often extraconic, ill defined and less homogenous in its enhancement.



Davis . ER, Hesselink TR, Dallow R, Grove AS Jr CT and ultrasound in the diagnosis of cavernous hemangioma and  lymphangioma of the orbit CT J comput assisted tomogr 4: 98 104 1980.

Bilamuk Lt, Zimmermon RA.

MRI of the orbit: Radiol clin, North  AM 25: 509 528; 1987.



Dr. Ashok Raghavan, Manipal Hospital, Bangalore