ORBITAL LYMPHANGIOMA

37 yr old male Patient sudeen onset proptosis in

the Rt eye with associated Redness x 12

days.

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

PRESENT CASE

Large macrolobulated intraconal / extraconal mass In the Rt Retroorbital region with following features :1. Fluid signal levels with acute / subacute

stage haemorrhage2. Minimal post contrast enhancement 3. Sudden onset proptosis .

Some facts ................................

Lymphangioma is a benign vascular tumourwhich is probably congenital, slowly growingand may not become clinically apparent formonths and for years.The tumour may affectthe conjunctiva, the lids and the orbit. Associatedsimilar extraorbital lesions include facialand palatal cystic lesions. Intracranial vascularanomalies have been reported to be associated

with the lesion.

Intraconal / extra conal mass with macrolobulation is appreciated in the Rt orbit.

Multiple fluid signal levels are appreciated . Supernatant and subnatant signal corroborates

with acute / subacute stage haemorrhage.

POST CONTRAST ENHANCEMENT IS MINIMAL – SUPPORTS LYMPHANGIOMA AS POSSBILITY

FLUID LEVELS IN MULTIPLE

PLANES

Differentiate haemorrhagic cysts

from the lymphangitic cysts .

( Haemorrhagic cysts have variable signal as

per stage)( Lymphatic cysts have hypointense signal on T1 and hyperintense

signal on T2 )

GRADIENT SEQUENCE DONE TO ASSESS BLOOM IN THE FLUID SIGNAL LEVELS - Rules out chronic haemorrhage

LOBULATED CONTOUR WITH MASS EFFECT ON THE ADJACENT MUSCLE COMPARTMENTS .

PYRAMIDAL SHAPE OF THE LESION WITH BASE TOWRADS THE GLOBE

Lesson learnt........................

• MR angiogram of the brain should be combined with Routine imaging of the orbital lesion to assess the connection of the orbital lesion with intracranial arterial / venous channels.

• Another terminology used for such kind of lesions is combined venous lymphatic -vascular malformations.

• Types of lymphangioma – Orbital , Superficial , Combined, – Superficial lymphangioma – Preseptal compartment.– Orbital lymphangioma – Post septal compartment.

( Both intraconal / extra conal components ).– Combined lymphangioma – Both preseptal and post septal

compartments.