Intraorbital capillary hemangioma: color and power Doppler findings

Clinical History

A two-month-old male child presented with a mass located in the anterosuperior and medial part of the right orbit, which was found to enlarge in size with weeping. Sonography showed a soft-tissue mass, which was prominent in the color-Doppler flow and the power-Doppler scan.

Imaging Findings

A two-month-old male presented with a tumor in the internal region of the right superior eyelid, which his parents had discovered, which was found to increase in size with weeping. The child was therefore sent to the paediatric ophthalmology service of our hospital for further evaluation. A clinical examination revealed a soft mass palpable in the superointernal angle of the right orbit, with no changes in the skin color. A sonography of the orbit and the right eye with a 15-7 MHz transducer and a Philips HDI 5000 equipment (Royal Philips Electronic, Eindoven, Netherlands) evidenced a well-circumscribed, soft-tissue, hyperechoic intraorbital mass located in the anterosuperior and medial angle (Fig. 1), whose inner part was prominent in the color-Doppler flow and the power-Doppler scan (Fig. 2a and b). The spectral analysis of vessels showed a high Doppler shift over 11 cm/s (Fig. 2c). The diagnosis was that of an intraorbital capillary hemangioma.

Discussion

Intraorbital capillary hemangiomas are present at birth or demonstrated in the first weeks of life. This type of tumor occurs in females more frequently than in males; it grows rapidly and spontaneously regresses after some years. They are frequently located in the anterior part of the orbit, which is the opposite of the cavernous hemangioma which is generally intraconal, although a capillary hemangioma can also be located posteriorly. The size varies from a few centimetres to millimetres. The sonographic findings consist of an intraorbital well-defined soft-tissue mass that is also hyperechoic due to the high quantity of capillaries in its interior part. Color-Doppler and power-Doppler scans show a prominent flow in the inner part of the mass. The differential diagnosis can include the rhabdomyosarcoma. This neoplasm appears more frequently in children between 8 and 10 years of age. Sonography shows a heterogeneous, infiltrative and ill-defined mass of low or medium echogenicity which appears contiguous with the muscle. It may extend frequently from bone and soft tissues. In most of the cases (80%–90%), no complication is evidenced and it just simply needs a follow-up until its total regression. But 10%–20% of the capillary hemangiomas can affect the function of the eye, therefore some type of treatment is required. Treatment can consist of laser therapy, steroids (systemic or intralesional), interferon, radiation, surgery or a combination of them. The sonographic examination not only allows the diagnosis of the lesion but also allows the monitoring of the effects of the treatment on the capillary hemangioma.

Differential Diagnosis List

Final Diagnosis

Intraorbital capillary hemangioma.

URL:	https://eurorad.org/case/3420
DOI:	10.1594/EURORAD/CASE.3420
ISSN:	1563-4086