Vascular Lesions Of The Orbit

1. Vascular Lesions of the Orbit More than Meets the Eye Smoker et al : From the Departments of Radiology (W.R.K.S., N.K.Y.) and Ophthalmology (J.A.N.), University of Iowa Hospitals and Clinics 2008; 28:185–204 Present by Ekkasit S. MD

4. Capillary Hemangiomas

8. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Hemangioma

10. Capillary Hemangiomas (Benign Hemangioendothelioma) Treatment options include observation and topical, oral, or intralesional corticosteroid therapy. Interferon therapy, laser therapy, and surgery typically are reserved for patients with potentially life-threatening complications .

12. Copyright ©Radiological Society of North America, 2008 CECT Capillary hemangioma in a 4-month-old boy with proptosis of the left eye, inferior displacement of the globe, and a bluish discoloration under the skin

14. Copyright ©Radiological Society of North America, 2008 Axial T1-weighted MR image Typical capillary hemangioma in a 41/2-month-old girl with proptosis of the right eye and cutaneous hemangioma

15. Axial T2-weighted fat-suppressed image Typical capillary hemangioma in a 41/2-month-old girl with proptosis of the right eye and cutaneous hemangioma

16. Copyright ©Radiological Society of North America, 2008 Axial contrast-enhanced T1-weighted fat-suppressed image Typical capillary hemangioma in a 41/2-month-old girl with proptosis of the right eye and cutaneous hemangioma

17. Venous Vascular Malformations Cavernous Malformations / Orbital Varices

20. Cavernous Malformations (cavernous hemangiomas) At histologic analysis, large dilated vascular channels lined by flattened or attenuated endothelial cells with an intervening fibrous interstitium are visible

24. Copyright ©Radiological Society of North America, 2008 CECT Cavernous malformation in a 39-year-old woman with painless progressive proptosis

26. Copyright ©Radiological Society of North America, 2008 Axial T1-weighted MR image Large cavernous malformation in a 43-year-old woman with painless proptosis of the right eye

27. Copyright ©Radiological Society of North America, 2008 Axial contrast enhanced T1-weighted fat-suppressed, image, obtained immediately after the intravenous administration of a gadolinium-based contrast material Large cavernous malformation in a 43-year-old woman with painless proptosis of the right eye

28. Copyright ©Radiological Society of North America, 2008 Axial contrastenhanced T1-weighted fat-suppressed MR image, obtained 1 hour later Large cavernous malformation in a 43-year-old woman with painless proptosis of the right eye

29. Copyright ©Radiological Society of North America, 2008 Large cavernous malformation cavernous malformation in a 43-year-old woman with painless proptosis of the right eye

32. Copyright ©Radiological Society of North America, 2008 Photograph obtained with the patient at rest Conjunctival orbital varix in a 56-year-old man whose right eyelid bulges when straining Photograph obtained during the Valsalva maneuver

33. Copyright ©Radiological Society of North America, 2008 Conjunctival orbital varix in a 56-year-old man whose right eyelid bulges when straining Photograph obtained with the upper eyelid elevated

36. Copyright ©Radiological Society of North America, 2008 CECT image obtained with the patient at rest Bilateral orbital varices in a 27-year-old woman with a sensation of eye pressure when stooping to pick up her child CECT image obtained with the patient at Valsalva maneuver

38. Copyright ©Radiological Society of North America, 2008 Axial T1-weighted MR image obtained with the patient supine Orbital varix in a 33-year-old woman with proptosis when straining prone supine CE T1-weighted fat-suppressed images

39. Venous Lymphatic Malformations

42. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Venous lymphatic malformation in a 47-year-old woman with acute proptosis and restricted movement of the left eye

43. Copyright ©Radiological Society of North America, 2008 Venous lymphatic malformation in a 5-year-old girl during an upper respiratory tract viral infection. after the patient recovered from the viral infection

45. Venous Lymphatic malformations ( Lymphagioma ) Histologic analysis demonstrates delicate, bloodless, lymph-filled, endothelium-lined vascular channels of various luminal diameters. Intervening connective-tissue septa contain lymphocytes and fragile blood vessels (neovascular tufts) that are thought to be the sources of hemorrhage.

49. Copyright ©Radiological Society of North America, 2008 Axial T2-weighted fat-suppressed MR image Venous lymphatic malformation in an 11-year-old boy with progressive proptosis of the right eye and lateral displacement of the globe

51. Copyright ©Radiological Society of North America, 2008 Axial unenhanced CT image Venous lymphatic malformation in an 11-year-old boy with progressive proptosis of the right eye and lateral displacement of the globe

52. Arterial and Arteriovenous Lesions Arteriovenous Fistulas / Wyburn-Mason Syndrome / Carotid Cavernous Fistulas / Ophthalmic Artery Aneurysms

55. Copyright ©Radiological Society of North America, 2008 Lateral projection from catheter-based angiography demonstrates early filling of a dural arteriovenous fistula (black arrow) fed by a dilated right ophthalmic artery (arrowheads). Intracranial venous drainage is faintly visible (white arrow). (b) Lateral projection from a later phase of the same angiographic examination shows rapid filling of the large intracranial venous component of the malformation (arrows). Orbital arteriovenous malformation in a 33-year-old man with proptosis and visible pulsations of the globe

57. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Wyburn-Mason syndrome in a 16-year-old boy

59. Copyright ©Radiological Society of North America, 2008 Axial contrast-enhanced CT images Wyburn-Mason syndrome in a 16-year-old boy

61. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Right carotid cavernous fistula in a 67-year-old woman Photograph shows conjunctival injection and mild proptosis. The patient also had papilledema and a bruit over the eye.

63. Copyright ©Radiological Society of North America, 2008 Carotid cavernous fistula in a 52-year-old woman with proptosis, chemosis, and conjunctival injection Axial T2-weighted MR images Axial maximum intensity projection image from MR angiography

66. Copyright ©Radiological Society of North America, 2008 CECT Ophthalmic artery aneurysm in a 44-year-old woman with a subarachnoid hemorrhage

67. Copyright ©Radiological Society of North America, 2008 CT angiography Ophthalmic artery aneurysm in a 44-year-old woman with a subarachnoid hemorrhage

68. Tumors Hemangioblastomas / Hemangiopericytomas / Choroidal Hemangiomas / Choroidal Melanomas / Metastases

75. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Hemangiopericytoma

77. Copyright ©Radiological Society of North America, 2008 Axial contrast-enhanced CT Hemangiopericytoma in a 47-year-old man with proptosis of the left eye

79. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Hemangiopericytoma in a 47-year-old man with proptosis of the left eye

84. Copyright ©Radiological Society of North America, 2008 CECT Circumscribed choroidal hemangioma in an 8-year-old girl

85. Copyright ©Radiological Society of North America, 2008 Circumscribed choroidal hemangioma in an 8-year-old girl Axial unenhanced T1WI Axial unenhanced T2WI contrast-enhanced T1-weighted fat-suppressed

93. Axial contrast-enhanced T1-weighted fat-suppressed image Axial T1-weighted MR image Choroidal melanotic melanoma in a 51-year-old man with decreasing vision in the left eye Coronal T2-weighted MR image

95. Copyright ©Radiological Society of North America, 2008 Smoker, W. R. K. et al. Radiographics 2008;28:185-204 Choroidal metastasis from stomach carcinoma in a 55-year-old man Axial T1-weighted MR image Axial T2-weighted MR image Axial contrastenhanced T1-weighted fat-suppressed MR image