Orbital venous anomalies demonstrated by spiral computed tomography.
OBJECTIVE
To describe the radiographic appearance of acute hemorrhage in orbital venous malformations and how spiral computed tomography (CT) can aid in the diagnosis of these lesions in patients with atypical presentations.


METHODS
Case series from the Eye Plastics and Orbital Service of Massachusetts Eye and Ear Infirmary. PARTICIPANTS/INTERVENTION/MAIN OUTCOME MEASURES: Three patients who initially presented with signs and symptoms of orbital hemorrhage are presented. Their initial clinical and radiologic imaging, follow-up examination, and results of the spiral CT are summarized.


RESULTS
The initial CT in each case showed a well-localized homogeneous mass in the posterior/inferior orbit. In the two cases without antecedent trauma, it was difficult to distinguish these localized hemorrhages from possible intraorbital neoplasm. On resolution of the hemorrhage, these three patients had different presentations. The first patient had intermittent proptosis that was documented by increase in exophthalmometry measurement before and after Valsalva maneuver (symptomatic and with clinical signs). The second patient had a subjective orbital pressure sensation, but no visible change by examination (symptomatic but without clinical signs). The third patient was not symptomatic and had no significant clinical findings (asymptomatic and without clinical signs). Spiral CT showed the presence of an enlarging inferior orbital mass during Valsalva maneuver, which was not apparent pre-Valsalva in all these patients.


CONCLUSIONS
Localized hemorrhages easily may be mistaken for solid intraorbital masses: therefore, accurate determination can avoid unnecessary surgical intervention. Patients with orbital venous malformation may or may not have symptoms and clinical signs of intermittent proptosis. After the resolution of the initial hemorrhage, spiral CT during Valsalva maneuver using a single breath hold technique is useful in showing the presence of this venous anomaly when suspicious of this entity, even in patients who are asymptomatic.
Rubin
P A
PA
Department of Ophthalmology Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Remulla
H D
HD
D000208:Acute Disease; D000328:Adult; D005131:Eye Injuries / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D009915:Orbit / Q000098:blood supply*; D019315:Retrobulbar Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014648:Varicose Veins / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000150:complications