Orbital Vascular Malformation

A 56-year-old male patient, known to have hypertension, presented to the Sultan Qaboos University Hospital in 2019 with a six-year history of gradually increasing left eye protrusion associated with reduced vision in the left eye. Ophthalmic examination revealed a significant proptosis in the left eye with an inferior displacement of the globe [Figure 1]. The best-corrected visual acuity was 6/9 and 6/24 in the right and left eye, respectively. Afferent pupillary defect was noted in the left eye, but slit-lamp biomicroscopy was unremarkable on both sides. Dilated fundus examination of the left eye showed an elevated optic disc with hazy borders. Left eye proptosis secondary to retrobulbar mass was the most likely aetiology and a magnetic resonance imaging (MRI) scan was performed. Open in a separate window Figure 1 Photograph of the eyes of a 56 year-old male patient showing the left eye protruding outward (proptotic). The MRI scan showed an oval-shaped retrobulbar intraorbital lesion measuring 3.0 × 2.7 × 3.1 cm (anteroposterior × craniocaudal × transverse) in size, displacing the orbit anteriorly, the optic nerve inferomedially and the superior and lateral rectus muscles peripherally [Figure 2]. The lesion showed high signal intensity in T2- and isointense signal in T1-weighted images with progressive enhancement starting as a patchy enhancement at the late arterial phase with a complete enhancement of the lesion in the delayed images [Figure 3]. Findings were consistent with orbital slow-flow vascular malformation which was likely a cavernous malformation. Open in a separate window Figure 2 Multi-sequential multi-planar magnetic resonance images of the head (orbits with intravenous contrast) of a 56-year-old male patient.A & B:Axial and coronal T2-weighted images showing an oval-shaped lesion (asterisk) in the retrobulbar intraconal space of the left orbit displacing the glob anteriorly (arrowhead), the optic nerve inferomedially (white arrow) and the superior and lateral rectus muscles (red arrows) peripherally. The lesion shows homogenous intermediate to high signal intensity in T2-weighted images.C:Sagittal precontrast T1-weighted image showing that the lesion is isointense to the cerebral cortex (asterisk). Open in a separate window Figure 3 Axial T1-weighted post-intravenous Gadolinium- enhanced images in the(A)late arterial and(B)delayed phase showing progressive enhancement (solid white arrows). The lesion is almost completly enhanced on the dela