ACUTE TUMOR OF THE LOWER LID DUE TO A SPONTANEOUS HEMORRHAGE CAUSED BY AN OCCULT VASCULAR MALFORMATION

Purpose To present an unusual acute tumour of the lid. Patient A 37-ye ar-old female physician presented with a swelling and a slight hematom a of the right lower lid. Palpation revealed two firm painless nodules under an intact epidermis. The patient confirmed that the lesion had developed within only one day without a preceding trauma. Both eyes we re morphologically and functionally normal. Motility was free, and the re was no exophthalmus. After three weeks the palpable nodules had not changed substantially. Magnetic resonance imaging disclosed a space-o ccupying lesion resembling an old hemorrhage or an inflammation. Excis ion was performed which revealed a thrombus-like structure. Histology showed multiple endothelium-lined vessels that were densely filled wit h erythrocytes, hemorrhages within the connective tissue, and old hemo siderin deposits. However, no thrombus could be found. Conclusion Alth ough thrombosis was the preferred diagnosis on clinical findings, hist ology led to the diagnosis of a spontaneous hemorrhage most likely cau sed by an occult vascular malformation.