hemangioma of orbit

Hemangioma of the Orbit: A Benign Tumor

A hemangioma of the orbit, also known as a cavernous hemangioma or capillary hemangioma, is a type of benign tumor that affects the orbit, which is the bony cavity that contains the eyeball. This tumor is characterized by an abnormal growth of blood vessels within the muscle cone of the orbit.

Types of Hemangiomas

There are two main types of hemangiomas that affect the orbit:

• Cavernous Hemangioma: This type of hemangioma is a benign, slowly progressive vascular neoplasm surrounded by a fibrous capsule. It most commonly presents in middle-aged adults and women are affected more than men.
• Capillary Hemangioma: This type of hemangioma is a hamartoma—an abnormal, localized proliferation of vascular endothelial cells. It is one of the most common benign orbital tumors in children.

Symptoms

The symptoms of a hemangioma of the orbit may include:

• A painless, slowly progressive bulging of the globe (proptosis)
• Reduction in visual acuity and presence of visual field defects
• Strabismic amblyopia can be caused by either mass effect in the orbit or direct involvement of the extraocular muscles

Imaging Features

The imaging features of a hemangioma of the orbit may include:

• A well-circumscribed, ovoid intraconal mass on cross-sectional imaging (such as CT or MRI)
• Displacement of the optic nerve medially by the orbital hemangioma
• Hyperechoic and compressible lesions with high peak intra-tumoral arterial shift on ultrasound

References

[1] Cavernous venous malformation (cavernous hemangioma) of the Orbit ICD-9-CM 225.0 [2] Capillary hemangioma is a hamartoma—an abnormal, localized proliferation of vascular endothelial cells. [3] The cavernous venous malformation of the orbit, previously called cavernous hemangioma, is the most common primary orbital lesion of adults.

Common Signs and Symptoms of Hemangioma of Orbit

Hemangioma of the orbit, also known as cavernous hemangioma, is a benign tumor that can cause various signs and symptoms due to its growth in the confined space of the orbit. Here are some common symptoms associated with this condition:

• Painless, slowly progressive bulging of the globe: This is one of the most obvious symptoms, where the eye appears to be bulging outwards (proptosis) [10].
• Decrease in visual acuity and visual field defects: As the tumor grows, it can press on the optic nerve, leading to vision loss or other visual disturbances [5, 6].
• Double vision or diplopia: The extraocular muscles may be affected, causing double vision or difficulty moving the eye normally [9].
• Lagophthalmos: This is a condition where the eyelid cannot close properly due to muscle dysfunction [9].
• Proptosis without overlying skin findings: In some cases, the tumor can cause proptosis without any visible signs on the skin [8].

Other Possible Symptoms

In addition to these common symptoms, hemangioma of the orbit may also be associated with:

• Vision not usually affected unless mass is pushing on the eye
• May cause optic nerve compression leading to visual loss, gaze-evoked amaurosis, or other visual disturbances
• Blurred vision, dizziness, fatigue, headache, hearing loss, memory loss, slurred speech, and tremors [3]

It's essential to note that these symptoms can vary in severity and may not be present in all cases. If you suspect a hemangioma of the orbit, it's crucial to consult with an eye specialist or a medical professional for proper diagnosis and treatment.

Diagnostic Tests for Hemangioma of the Orbit

Hemangiomas of the orbit can be diagnosed using various imaging tests and physical examinations. Here are some of the common diagnostic tests used to diagnose hemangioma of the orbit:

• Imaging Tests:
  • Computed Tomography (CT): CT scans can help identify the location, size, and extent of the hemangioma [3].
  • Magnetic Resonance Imaging (MRI): MRI is a more sensitive test than CT and can provide detailed images of the hemangioma and its relationship to surrounding structures [2].
  • Ultrasound: High-resolution B-scan ultrasonography can aid in the preoperative diagnosis of hemangiomas of the orbit [5].
  • Plain Film Radiography: Plain X-rays may show calcifications or other abnormalities within the hemangioma [3].
• Physical Examination:
  • A thorough physical examination by a healthcare provider is essential to diagnose hemangioma of the orbit. The provider will review your symptoms and perform a physical exam to assess the size, shape, and location of the tumor.
• Other Tests:
  • Laboratory Testing: Laboratory testing may be directed by the clinician's suspicion level of the presumed etiology of the lesion [4].
  • Dynamic Contrast MRI: Dynamic contrast MRI can help differentiate hemangioma from schwannoma of the orbit [7].

It is essential to note that a combination of imaging tests and physical examinations is often used to diagnose hemangioma of the orbit. The choice of diagnostic test depends on the individual case and may involve consultation with an ophthalmologist or other specialists.

References:

[1] Not provided in context

[2] by L Zhang · 2020 · Cited by 22 — Current diagnostic imaging methods for CHM mainly include ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). With the ...

[3] by BG Haik · 1979 · Cited by 252 — Diagnostic tests of most value were plain radiography, ultrasonography, computed axial tomography, and arteriography. The complication rate in the 50 patients ...

[4] Mar 20, 2023 — Laboratory testing should be directed by the clinician's suspicion level of the presumed etiology of the lesion.

[5] by DJ Coleman · 1972 · Cited by 25 — High resolution B-scan ultrasonography, a safe and effective method for diagnosing hemangiomas of the orbit.

[6] Not provided in context

[7] by L Zhang · 2020 · Cited by 22 — Dynamic contrast MRI can help differentiate hemangioma from schwannoma of the orbit.

Treatment Options for Hemangiomas of the Orbit

Hemangiomas of the orbit can be treated with various options, including drug treatment.

• Propranolol: A study published in 2021 reported a successful treatment of an isolated deep orbital hemangioma in a 2-month-old infant using oral propranolol [7]. This suggests that propranolol may be a viable option for treating hemangiomas of the orbit, especially in infants.
• Other pharmacologic therapies: In addition to propranolol, other pharmacologic therapies such as corticosteroids and embolization agents have been used to treat hemangiomas of the orbit [6]. However, the effectiveness and safety of these treatments may vary depending on the individual case.

Important Considerations

• Age and size: The age and size of the patient can influence the choice of treatment. For example, propranolol may be more suitable for infants with small hemangiomas.
• Location and symptoms: The location and symptoms of the hemangioma can also impact the decision-making process. For instance, a hemangioma causing significant visual disturbance or optic nerve compression may require more aggressive treatment.

References

[7] Zvizdic D. Isolated deep orbital hemangioma treated successfully with oral propranolol in a 2-month-old infant: Case report with literature review - ScienceDirect. [6] Fay A. Direct interventional treatments for infantile hemangioma such as local corticosteroid injection, laser therapy, embolization, and surgery, while suitable for...

The differential diagnosis for a well-circumscribed, round to oval, solid orbital mass, including hemangioma, involves several conditions that can mimic its appearance on imaging studies.

Key Differential Diagnoses:

• Schwannoma: A rare lesion of the orbit that can be confused with cavernous hemangioma on imaging studies [8].
• Hemangiopericytoma: A vascular tumor that can present as a well-circumscribed, solid mass in the orbit [2].
• Sclerosing Hemangioma: A variant of hemangioma that can appear as a well-defined, solid mass in the orbit [2].
• Optic Nerve Meningioma: A benign tumor that can present as a well-circumscribed, solid mass in the orbit, often associated with optic nerve enhancement on imaging studies [5].

Imaging Features:

• Contrast-Enhancement Spread Pattern: Dynamic MRI can help differentiate between hemangioma and schwannoma based on the contrast-enhancement spread pattern [6].
• Flow Voids and Vessel Association: Prominent flow voids and vessel association are characteristic of venolymphatic malformation (previously known as lymphangioma), which is a differential consideration for hemangioma [11].

Clinical Considerations:

• Age and Location: The patient's age and the extraconal location of the lesion can support the diagnosis of capillary hemangioma, although venolymphatic malformation is also a differential consideration [11].
• Natural History and Growth Pattern: Vascular lesions of the orbit can be classified based on their natural history, growth pattern, and histologic composition as capillary hemangiomas, venous vascular malformations, venous lymphatic malformations, arterial and arteriovenous lesions, or neoplasms [13].

References:

• Warner EJ, Burkat CN, Gentry LR. Orbital fibrous histiocytoma mimicking cavernous hemangioma on dynamic MRI. Orbit 2010;29(6):354-356.
• Tanaka A. Hemangioma and schwannoma of the orbit can be differentiated by the contrast-enhancement spread pattern on dynamic MRI. Journal of Neuro-Ophthalmology 2005;25(2):93-98.
• Other references in the context are also relevant to this topic.