PURPOSE: To illustrate that orbital venous-lymphatic malformations (lymphan
giomas) may rarely simulate cavernous hemangiomas,
METHODS: Retrospective case review.
RESULTS: Five patients were identified from a series of 85 patients with ve
nous-lymphatic malformations. The age range was 21 to 69 years, and all cas
es presented with a history of slowly progressive or long-standing proptosi
s, Computerized tomography revealed relatively homogeneous intraconal masse
s that were well defined anteriorly, Two of the cases had expansion of the
orbit, and one had focal calcification. The three who had magnetic resonanc
e imaging showed heterogeneous contrast enhancement. The preoperative diagn
osis in every case was cavernous hemangioma, and intraoperatively the lesio
ns resembled cavernous hemangiomas. However, posterior dissection was diffi
cult in all patients because of dense adhesions and, in one case, led to a
central retinal artery occlusion, The histology was characteristic of orbit
al venous-lymphatic malformations in all five cases.
CONCLUSIONS: Deep orbital venous-lymphatic malformations presenting in adul
thood may be rarely confused with cavernous hemangiomas. In doubtful cases,
significant intralesional heterogeneity, best seen on magnetic resonance i
maging, and focal calcification may help distinguish the two entities. This
differentiation is important, because dissection of venous-lymphatic malfo
rmations is fraught with more complications than surgical excision of a cav
ernous hemangioma, (Am J Ophthalmol 2001;131: 364-370. (C) 2001 by Elsevier
Science Inc. All rights reserved.).