A patient presented to the ER complaining of 2 days of increasing pain and swelling behind the left eye. Of note the patient reported that as a teenager he was previously treated for an orbital tumor. On exam he was found to have massive proptosis, hyperglobus and restricted extraocular motility in all gazes on the left. Vision was 20/40, Ishihara color plates were full, and no APD was noted in the affected eye. An MRI of the orbits revealed a T2 hyperintense, T1 isointense lobulated extraconal mass in the left medial orbit with areas showing small blood-fluid levels. Based on the history and imaging findings the diagnosis of orbital venous lymphatic malformation was made. The lesion was further characterized by cerebral angiography, which identified small tortuous feeder vessels off the inferior orbital branch of the left ophthalmic artery and distal internal maxillary artery. These vessels were not adequate for embolization. The patient therefore underwent surgical excision of the lesion through a pterional craniotomy and anterior orbitotomy. Postoperatively the patient showed marked decrease in proptosis and improvement in extraocular motility without any loss of vision.
Presentation Date: 03/25/2021
Issue Date: 04/02/2021