Objective: To describe the radiographic appearance of acute hemorrhage
in orbital venous malformations and how spiral computed tomography (C
T) can aid in the diagnosis of these lesions in patients with atypical
presentations. Design: Case series from the Eye Plastics and Orbital
Service of Massachusetts Eye and Ear Infirmary. Participants/Intervent
ion/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 o
f the spiral CT are summarized. Results: The initial CT in each case s
howed a well-localized homogeneous mass in the posterior/inferior orbi
t, In the two cases without antecedent trauma, it was difficult to dis
tinguish these localized hemorrhages from possible intraorbital neopla
sm. On resolution of the hemorrhage, these three patients had differen
t presentations. The first patient had intermittent proptosis that was
documented by increase in exophthalmometry measurement before and aft
er Valsalva maneuver (symptomatic and with clinical signs). The second
patient had a subjective orbital pressure sensation, but no visible c
hange by examination (symptomatic but without clinical signs). The thi
rd patient was not symptomatic and had no significant clinical finding
s (asymptomatic and without clinical signs), Spiral CT showed the pres
ence of an enlarging inferior orbital mass during Valsalva maneuver, w
hich was not apparent pre-Valsalva in all these patients. Conclusions:
Localized hemorrhages easily may be mistaken for solid intraorbital m
asses; therefore, accurate determination can avoid unnecessary surgica
l intervention, Patients with orbital venous malformation may or may n
ot have symptoms and clinical signs of intermittent proptosis, After t
he resolution of the initial hemorrhage, spiral CT during Valsalva man
euver using a single breath hold technique is useful in showing the pr
esence of this venous anomaly when suspicious of this entity, even in
patients who are asymptomatic.