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Case Reports
. 2020 Aug 28;15(3):750-752.
doi: 10.4103/ajns.AJNS_236_20. eCollection 2020 Jul-Sep.

A Cavernous Venous Malformation of the Orbit Mimicking an Idiopathic Orbital Inflammation

Niphon Chirapapaisan  1 , Chanon Ngamsombat  2 , Jantima Tanboon  3 , Pornsuk Cheunsuchon  3 , Sugamon Koohasawad  4
Affiliations
Case Reports

A Cavernous Venous Malformation of the Orbit Mimicking an Idiopathic Orbital Inflammation

Niphon Chirapapaisan et al. Asian J Neurosurg. .

Abstract

Orbital cavernous venous malformations (CVMs) are usually slow progressing. Multiple CVMs, bilateral orbital CVMs, and acute presentations are rare. We present a rare, bilateral, orbital CVM with acute painful visual loss in the left eye. The initial clinical presentation mimicked an idiopathic orbital inflammation. Orbital magnetic resonance imaging revealed its rare location at the left orbital apex. Finally, pathology confirmed the presence of an intralesional hemorrhage of a CVM.

Keywords: Cavernous venous malformations; idiopathic orbital inflammation; orbital.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The computed tomography scan of the orbit showed a homogeneous, enhancing mass at the left orbital apex (Fig 1.a) adhering to the left superior rectus (Fig1.b) and medial rectus muscles (Fig1.a) and causing lateral compression on the left optic nerve (arrow). Furthermore, there was a small enhancing nodule at the right orbital apex (Fig 1.a, arrow head)
Figure 2
Figure 2
A blue–green soft nodule was present on the left cheek
Figure 3
Figure 3
A homogeneous lesion at the infraorbital area of the left cheek was just lateral to the left nasal ala (arrow)
Figure 4
Figure 4
The magnetic resonance imaging scan revealed that an ill-defined, intraconal mass at the medial portion of the left orbit (arrow) was causing a lateral pressure effect on the optic nerve. The mass showed iso-to-low signal intensity on T1W, low signal intensity on T2W, and peripheral patchy enhancement. It involved part of the left superior oblique and left medial rectus muscles. However, some central portions displayed a very low signal intensity on T2W without enhancement, suspicious of a hemorrhagic component. There was another lobulated, intraconal nodule at the right orbital apex with homogeneous enhancement (arrow head)
Figure 5
Figure 5
(a) Hematoxylin and eosin staining revealed collapsed, thin-walled, vascular channels (*) associated with organized thrombus. (b) CD31 staining highlighted the endothelial cells of the collapsed lumen (arrow head). (c) Smooth muscle actin (SMA) staining highlighted the smooth muscle cells in the vascular wall
See this image and copyright information in PMC

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