Clinical Features

Capillary hemangioma of the eyelid or orbit is usually apparent at birth or within the first 8 weeks of life.15 Females may be affected slightly more often than males.20'21 About 83% of capillary hemangiomas occur in the anterior orbit. The tumor is usually palpable in the anterior orbit' with or without some extension into the eyelid, giving the appearance of a red cutaneous lesion (Figures 14.3, 14.4, and 14.5). About 17% of capillary hemangiomas occur deep in the orbit (Figure 14.6).21 When the lesion is confined to the deep orbital structures, a child may show only proptosis and displacement of the globe. Astigmatic and myopic refractive errors can

FIGURE 14.4. One-year-old boy with a capillary hemangioma involving the left inferior orbit. (A) Facial photograph showing bluish discoloration, swelling of the left lower eyelid, and upward displacement of the eyeball by the inferiorly located orbital capillary hemangioma. (B) Tl-weighted coronal MR image demonstrating the inferiorly located capillary hemangioma with marked contrast enhancement. Note the signal-void areas representative of high flow vessels. (C) Postoperative facial photograph 6 months after excision of the lesion. There is no superior displacement of the globe.

FIGURE 14.5. (A) Large lower eyelid anterior orbit hemangioma photographed before steroid injection. (B,C) Appearance and size of the lesion postoperatively, 8 and 13 months after injection, respectively.

FIGURE 14.4. One-year-old boy with a capillary hemangioma involving the left inferior orbit. (A) Facial photograph showing bluish discoloration, swelling of the left lower eyelid, and upward displacement of the eyeball by the inferiorly located orbital capillary hemangioma. (B) Tl-weighted coronal MR image demonstrating the inferiorly located capillary hemangioma with marked contrast enhancement. Note the signal-void areas representative of high flow vessels. (C) Postoperative facial photograph 6 months after excision of the lesion. There is no superior displacement of the globe.

FIGURE 14.5. (A) Large lower eyelid anterior orbit hemangioma photographed before steroid injection. (B,C) Appearance and size of the lesion postoperatively, 8 and 13 months after injection, respectively.

be demonstrated in almost half of the patients with sizable lesions involving the upper eyelid and orbit.22 Other tumors that should be considered in the differential diagnosis of capillary hemangioma include teratoma, metastatic neuroblastoma, and, rarely, rhabdomyosarcoma.

The capillary hemangioma usually enlarges for several months and then slowly regresses without treatment. Approximately 70% of the capillary hemangiomas regress completely by 7 years of age.22 The child with eyelid or orbital capillary hemangioma may also have capillary hemangiomas in several visceral (pulmonary, soft tissues, and skin) organs. In the case of extensive visceral hemangiomas, secondary thrombo-cytopenia, due to entrapment of platelets in the tumor, can lead to extensive hemorrhage, a condition known as Kasabach-Merritt syndrome. Subglottic hemangiomas can result in respiratory distress.21

FIGURE 14.6. Facial photographs of a 3-year-old girl with corresponding coronal CTs before and after steroid injection. The lesion proved to be a vascular hamartoma with mixed capillary, cavernous, and lymphangiomatous components that responded well to steroid injection (G) but later developed a spontaneous orbital hemorrhage (I). (A,B) Initial presentation. (C,D) Enlarged lesion prior to injection. (E,F) Three days postinjection, whitish steroid deposits are seen in the slit lamp photo (arrow). (G,H) Four months after injection. (I,J) One year after injection.

Was this article helpful?

0 0

Post a comment