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Blue Rubber Bleb Nevus Syndrome Manifesting as an Isolated Congenital Orbital Mass in a Neonate. Ophthalmic Plast Reconstr Surg 2022; 38:e124-e127. [DOI: 10.1097/iop.0000000000002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Loecker K, Labarque V, Seynaeve H, Casteels I. Subconjunctival Hemorrhage in a Child with the Blue Rubber Bleb Nevus Syndrome on Treatment with Oral Propranolol. Case Rep Ophthalmol 2021; 12:451-456. [PMID: 34177541 PMCID: PMC8215979 DOI: 10.1159/000513504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare syndrome characterized by venous malformations of mostly skin and gastrointestinal tract. Patients present with multiple venous malformations in various organs including liver, spleen, heart, eye, and central nervous system. Few ophthalmological cases have been published in literature and at present, there are no clear guidelines on the treatment of eye hemorrhages associated with the BRBNS. We report a 3-year-old boy with the BRBNS who developed a spontaneous progressive enlarging subconjunctival hemorrhage in the left eye despite being treated with oral propranolol. The subconjunctival hemorrhage was caused by an underlying conjunctival vascular malformation. With topical treatment with timolol maleate 0.5% once a day in the affected eye, the lesion regressed completely after 4 months. This child represents the first case of the BRBNS associated with a subconjunctival progressive bleeding necessitating topical treatment despite oral propranolol effectively controlling the cutaneous lesions. We recommend ophthalmic screening of patients with BRBNS in early childhood. For patients with BRBNS-related subconjunctival vascular lesions with subsequent hemorrhage, treatment with a topical β-blocker may be an efficient and harmless treatment option.
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Affiliation(s)
- Karen De Loecker
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department Pediatric Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Seynaeve
- Department of Ophthalmology, AZ Delta, Roeselare, Belgium
| | - Ingele Casteels
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Chirapapaisan N, Ngamsombat C, Tanboon J, Cheunsuchon P, Koohasawad S. A Cavernous Venous Malformation of the Orbit Mimicking an Idiopathic Orbital Inflammation. Asian J Neurosurg 2020; 15:750-752. [PMID: 33145246 PMCID: PMC7591188 DOI: 10.4103/ajns.ajns_236_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022] Open
Abstract
Orbital cavernous venous malformations (CVMs) are usually slow progressing. Multiple CVMs, bilateral orbital CVMs, and acute presentations are rare. We present a rare, bilateral, orbital CVM with acute painful visual loss in the left eye. The initial clinical presentation mimicked an idiopathic orbital inflammation. Orbital magnetic resonance imaging revealed its rare location at the left orbital apex. Finally, pathology confirmed the presence of an intralesional hemorrhage of a CVM.
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Affiliation(s)
- Niphon Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanon Ngamsombat
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornsuk Cheunsuchon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sugamon Koohasawad
- Department of Ophthalmology, Prasat Neurological Institute, Bangkok, Thailand
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Fragiotta S, Sepe M, Perdicchi A, Scuderi L, Trani M, Scuderi G. Postural changes revealing orbital venous malformation using ultrasound in blue rubber bleb nevus syndrome. Orbit 2019; 39:293-297. [PMID: 31691617 DOI: 10.1080/01676830.2019.1688357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 62-year-old white woman presented with a diagnosis of blue rubber bleb nevus syndrome (BRBNS). The right eye appeared enophthalmic, yet the patient complained of episodes of right proptosis on bending forward. The remainder of the examination was unremarkable. Orbital ultrasound (US) in an upright posture revealed a single low reflectivity cavity (4.27 mm x 2.82 mm) of uncertain interpretation. In a forward-leaning posture the lesion increased in size (maximum thickness of 13.72 mm), demonstrating multiple low reflectivity spaces with highly reflective septae. This case first reports the use of US with postural changes to assess the presence of orbital venous malformation in BRBNS. The expansile nature upon postural changes supports the venous origin of the orbital lesion.
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Affiliation(s)
- Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Massimiliano Sepe
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Andrea Perdicchi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome "Sapienza" , Rome, Italy
| | - Maria Trani
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
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Abstract
Cavernous hemangioma of the orbit (CHO) is a benign slow-growing lesion of intracanal space. Bilateral orbital cavernous hemangiomas are extremely rare, so that only a few cases have been reported in scientific literature. A 54-year-old patient presented a 1-year history of impaired visual acuity of the left eye. Physical examination showed a left axial propotosis. Orbital magnetic resonance imaging showed a 28 mm diameter intraconal space mass of the left orbit, as well as another 11 mm diameter lesion in the right eye, in the superomedial extraconal space. A superior wall left orbitotomy was performed with a total removal of the tumor. The right lesion was respected. Histopathological examination confirmed the diagnosis of CHO. Bilateral cavernous hemangiomas are extremely rare. Orbital imaging guides the diagnosis. The neurosurgeons prefer craniotomy while ophthalmologists favor various modifications of orbitotomies.
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Affiliation(s)
- Aslam Hentati
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Nidhal Matar
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Hadhemi Dridi
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Soufien Bouali
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, El Manar-Tunis university, Faculty of Medicine of Tunis, National Institute of neurology, Tunis, Tunisia
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Proptosis Reduction Using Sirolimus in a Child With an Orbital Vascular Malformation and Blue Rubber Bleb Nevus Syndrome. Ophthalmic Plast Reconstr Surg 2017; 33:S143-S146. [DOI: 10.1097/iop.0000000000000692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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7
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Gupta S, Kaliki S, Gowrishankar S. Concomitant orbital cavernous haemangioma and schwannoma in a patient. BMJ Case Rep 2017; 2017:bcr-2016-218638. [PMID: 28082308 DOI: 10.1136/bcr-2016-218638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman aged 39 years presented with right eye painless proptosis and decreased vision since 5 months. Right fundus examination revealed optic disc oedema. CT of the orbit revealed a well-defined homogeneous mass in the intraconal space in both orbits. Surgical excisional biopsy of the orbital lesions was performed. Histopathological examination of the right orbital lesion was suggestive of cavernous haemangioma and the left orbital lesion revealed schwannoma. The patient had an unremarkable postoperative course with improved visual acuity. This case illustrates benign orbital masses of 2 different tissues of origin in a single patient, which has not been described in the literature.
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Affiliation(s)
| | - Swathi Kaliki
- Department of Ocular Oncology, L V Prasad Eye Institute, Hyderabad, India
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Orbital Varix Thrombosis and Review of Orbital Vascular Anomalies in Blue Rubber Bleb Nevus Syndrome. Ophthalmic Plast Reconstr Surg 2016; 31:e82-6. [PMID: 24879057 DOI: 10.1097/iop.0000000000000107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 57-year-old woman with cutaneous manifestations of (BRBNS) presented with acute left proptosis and venous congestion secondary to thrombosis within a superior ophthalmic vein varix. Multiple phleboliths were noted in the contralateral right orbit, and an incidental right middle cerebral artery aneurysm. Her symptoms spontaneously resolved within a few days. An English literature review found 7 reported cases of orbital vascular lesions in association with BRBNS from 1950 to 2012. All lesions showed contrast enhancement on CT or MRI: 4 had small orbital calcifications and 3 were distensible with raised venous pressure. The occurrence of a thrombosed orbital varix or cerebral artery aneurysm in BRBNS, to the best of the authors' knowledge, has not been previously reported. Although orbital vascular lesions in BRBNS have been described as hemangiomas, the biologic behavior and histology of most of the reported orbital lesions are most compatible with venous malformations.
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Concomitant Multiple Cavernous Hemangiomas and Venous Angioma of the Orbit. J Craniofac Surg 2014; 25:e356-8. [DOI: 10.1097/scs.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Strianese D, Napoli M, Russo C, D'Errico A, Scotti N, Puoti G, Bonavolontà G, Tranfa F, Briganti F. Coexistence of cavernous hemangioma and other vascular malformations of the orbit. A report of three cases. Neuroradiol J 2014; 27:223-31. [PMID: 24750713 DOI: 10.15274/nrj-2014-10016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/09/2014] [Indexed: 11/12/2022] Open
Abstract
Coexistence of orbital cavernous hemangioma and other vascular malformations is unusual and few cases have been reported. We describe the clinical and radiological features of three cases of orbital cavernous hemangiomas associated with other vascular malformations, selected reviewing a series of 181 cases of cavernous hemangiomas. All patients were males (age ranging from 43 to 67 years) without vascular systemic disorders and/or a clinical syndrome. They experienced slow progressive exophthalmos. One of them developed acute pulsatile proptosis (case 2), while another experienced slow progressive diplopia (case 3). In one case vascular lesions were bilateral (case 3) and in two patients two different lesions coexisted in the same orbit (cases 1 and 2). All patients underwent surgical excision, which was partial in two cases. Two patients had cavernous hemangiomas in association with a venous malformation (a varix in case 1 and a lymphangioma in case 2), while in the other ones (case 3) cavernous hemangioma was associated with a low-flow arteriovenous malformation. No patient denied visual impairment postoperatively. Few cases of orbital cavernous hemangiomas coexisting with other vascular malformations have been reported in the literature. This entity seems to be an association of different variants of orbital vascular malformations, presenting with a wide spectrum of clinical forms and probably with the same pathogenesis.
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Affiliation(s)
- Diego Strianese
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy -
| | - Manuela Napoli
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Carmela Russo
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Arianna D'Errico
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
| | - Nadia Scotti
- Department of Pediatrics, "Federico II" University; Naples, Italy
| | - Gianfranco Puoti
- I Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Naples, Italy
| | - Giulio Bonavolontà
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Fausto Tranfa
- Department of Neurosciences and Reproductive Sciences, "Federico II" University; Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, "Federico II" University; Naples, Italy
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Rootman DB, Heran MKS, Rootman J, White VA, Luemsamran P, Yucel YH. Cavernous venous malformations of the orbit (so-called cavernous haemangioma): a comprehensive evaluation of their clinical, imaging and histologic nature. Br J Ophthalmol 2014; 98:880-8. [DOI: 10.1136/bjophthalmol-2013-304460] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Petek B, Jones RL. The management of ophthalmic involvement in blue rubber bleb nevus syndrome. GMS OPHTHALMOLOGY CASES 2014; 4:Doc04. [PMID: 27625939 PMCID: PMC5015613 DOI: 10.3205/oc000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: Blue rubber bleb nevus syndrome is a rare vascular disease most commonly associated with venous malformations of the skin and the gastrointestinal tract. Few ophthalmic cases have been reported to date, and no clear treatment regimen exists. We describe the case of a 59-year-old man, along with a review of literature, to help in the future diagnosis and treatment of patients with the disease. Methods: This paper is an observational case report and a review of medical literature on the syndrome from 1981 to present. Results: Our patient developed a dural arteriovenous fistula in his orbit after being diagnosed with a familial form of blue rubber bleb nevus syndrome. Multiple endovascular embolization procedures eliminated all of his ocular symptoms. Surgical procedures were also successful in other cases reviewed, and similar symptoms were seen across cases. Conclusions: Comparing our case with other ophthalamic reports in literature, surgical intervention appears to be a plausible long-term treatment for optic manifestations of blue rubber bleb nevus syndrome. Systemic therapies, including sirolimus and corticosteroids, have had limited success in the long-term treatment of other forms of blue rubber bleb nevus syndrome, and therefore are not recommended in the treatment of ocular symptoms.
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Affiliation(s)
- Bradley Petek
- University of Washington Medical Center, Seattle, USA
| | - Robin L Jones
- Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, USA
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Diamantopoulou A, Damianidis C, Kyriakou V, Kotziamani N, Emmanouilidou M, Goutsaridou F, Tsitouridis I. Orbital cavernous hemangiomas: ultrasound and magnetic resonance imaging evaluation. Neuroradiol J 2010; 23:99-108. [PMID: 24148341 DOI: 10.1177/197140091002300117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 11/17/2022] Open
Abstract
Cavernous hemangioma is the most common intraorbital lesion in adults. The aim of our study was to evaluate the magnetic resonance imaging (MRI) and ultrasound (US) characteristics of cavernous hemangioma and their role in the differential diagnosis of orbital tumors. Eight patients with orbital cavernous hemangiomas, five women and three men with a mean age of 48 years were examined in a period of six years. All patients underwent MRI examination and four patients were also evaluated by US. In all cases MRI depicted a well-defined intraconal tumor. The lesions were homogeneous, isointense to muscle on T1-weighted sequence and hyperintense to muscle on T2-weighted sequence in six patients. In one patient the mass was isointense on T1WI with heterogeneous signal intensity on T2WI and in one patient the lesion had heterogeneous signal intensity on both T1- and T2-weighted sequences. After intravenous contrast medium administration, the tumors showed initial inhomogeneous enhancement with progressive accumulation of contrast material on delayed images in seven patients and initial homogeneous enhancement in one patient. On ultrasonography, the orbital masses appeared slightly hyperechoic, heterogeneous with small areas of slow blood flow. The analysis of imaging characteristics of a well-defined intraconal lesion in an adult patient with painless progressive proptosis can be highly suggestive of the diagnosis of cavernous hemangioma.
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Affiliation(s)
- A Diamantopoulou
- Radiology Department, Papageorgiou General Hospital; Thessaloniki, Greece -
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Multiple cavernous hemangiomas of the orbit: Separate occurrence within a 24-year period. VOJNOSANIT PREGL 2010; 67:507-10. [DOI: 10.2298/vsp1006507n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. Cavernous hemangioma is a frequent and the most common, primary, benign tumor of the orbit in adults. It is typically single and unilateral, considered not to recur after having been completely excised. Multiple orbital cavernous hemangiomas without signs of hemangiomatosis are rare. Multiple cavernous hemangiomas may recur after a complete excision and may exist with concurrent systemic tumors. Tumor recurrence is supposed to develop from vasculature that is present already in response to a proliferate stimulus. Case report. A 39-year old female with painless proptosis of the right orbit was found to have four orbital tumors. The first orbitotomy was performed in 1984 by excising four cavernous hemangiomas. Six years later, another, the fifth one cavernous hemangioma was totally excised from the same orbit. Nine years after the first operation, reorbitotomy was performed because of positive radiological and clinical signs of de novo tumor in the orbit. The operation did not confirm the tumorous tissue. The fourth orbitotomy was performed 24 years after the first operation and two cavernous hemangiomas were totally excised. Conclusion. This case show the possibility of cavernous hemangioma recurrence after a previously totally excised tumor, separated more than two decades. A very long follow-up of the patients operated for these benign tumor lesions is recommended.
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Wang Y, Kang L, Xiao L. Infrequent bilateral orbital tumors and simulating lesions: the experience of a Chinese institute. Jpn J Ophthalmol 2009; 53:629-634. [PMID: 20020243 DOI: 10.1007/s10384-009-0736-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the types, frequency, and clinical features of infrequent bilateral orbital lesions. METHODS We reviewed 41 cases of either histopathologically or radiologically verified bilateral orbital lesions. The number and entities in each category were recorded. Clinical data and imaging findings were reviewed. RESULTS The number and percentage of lesions in each general category were leukemia lesions in eight patients (19.5%), metastatic tumors in seven (17%), optic nerve and meningeal tumors in six (14.6%), secondary tumors in six (14.6%), peripheral nerve lesions in four (9.8%), inflammatory lesions in four (9.8%), and vasculogenic, histiocytic, and miscellaneous lesions, each in two patients (4.9%). These lesions occurred in both childhood and adulthood, but were infrequent in people over 60 years old. Of all cases, 51.2% were benign and 48.8% were malignant. The ocular symptoms and signs presented unilaterally in 18 (43.9%) cases and bilaterally in 23 (56.1%). Of the 15 patients with either metastatic tumors or blood disorders, two (13.3%) had a history of primary neoplasm at presentation. In 19 (46.3%) cases, the configuration of the bilateral lesions was symmetrical, and they were of equal size. Computed tomography scans revealed bone changes in 13 patients (31.7%), while magnetic resonance imaging revealed intracranial extension in nine (22%). CONCLUSIONS Varied lesions can involve the bilateral orbits simultaneously or on follow-up. Through the combination of history, bilateral ocular manifestations, radiologic findings, and systemic examinations, the correct diagnosis can be made, which is valuable for early identification of both metastasis and blood disorders.
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Affiliation(s)
- Yi Wang
- Institute of Orbital Diseases, Armed Police General Hospital, Beijing, China. .,Institute of Orbital Diseases, Armed Police General Hospital, No.69 Yongding Road, Haidian District, Beijing, China.
| | - Li Kang
- Institute of Orbital Diseases, Armed Police General Hospital, Beijing, China
| | - LiHua Xiao
- Institute of Orbital Diseases, Armed Police General Hospital, Beijing, China
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Multiple Orbital Venous Malformations Presenting With Enophthalmos in a Patient With Presumed Blue Rubber Bleb Nevus Syndrome. Ophthalmic Plast Reconstr Surg 2008; 24:331-4. [DOI: 10.1097/iop.0b013e31817d027a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paonessa A, Limbucci N, Gallucci M. Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study. Eur J Radiol 2008; 66:282-6. [PMID: 17644295 DOI: 10.1016/j.ejrad.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Revised: 05/14/2007] [Accepted: 06/04/2007] [Indexed: 10/23/2022]
Abstract
Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described. The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases. We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed. Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.
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Affiliation(s)
- Amalia Paonessa
- Department of Neuroradiology, S.Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
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Smoker WRK, Gentry LR, Yee NK, Reede DL, Nerad JA. Vascular Lesions of the Orbit: More than Meets the Eye. Radiographics 2008; 28:185-204; quiz 325. [DOI: 10.1148/rg.281075040] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kopácová M, Tachecí I, Koudelka J, Králová M, Rejchrt S, Bures J. A new approach to blue rubber bleb nevus syndrome: the role of capsule endoscopy and intra-operative enteroscopy. Pediatr Surg Int 2007; 23:693-7. [PMID: 17205297 DOI: 10.1007/s00383-006-1843-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2006] [Indexed: 12/12/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular malformation disorder with cutaneous and visceral lesions frequently associated with serious, even fatal bleeding and anemia. The syndrome is considered to be autosomaly predominantly inherited. Intra-operative enteroscopy (IOE) is the best method of identification of all lesions (particularly the small ones, less than 3 mm) and treatment by endoscopic electro-coagulation or surgical excision. Capsule wireless endoscopy is optimal for screening before the IOE and for monitoring the effect of therapy (in patients with BRBNS). We report two cases of BRBNS. Anemia, gastrointestinal bleeding, gastrointestinal malformations and multifocal venous malformations of the skin were present in both of our cases. Gastrointestinal lesions were identified by gastroscopy, colonoscopy and capsule endoscopy. The multiple venous malformations were treated partly by endoscopic electro-coagulation (lesions up to 4 mm in diameter) and by wedge resection. Both of our patients were 12-year-old girls at the time of operation. In the first patient 31 venous malformations of the small bowel were coagulated, two were resected by the surgeon. In the second patient 20 lesions were coagulated endoscopically and another 31 nevi were resected during an 8 h procedure. The first girl is doing fine 4 years after the procedure, the second was allowed home 2 weeks after the procedure in excellent condition. IOE is a unique method of small bowel investigation and concurrently provides a solution for pathological findings. Capsule endoscopy is a feasible non-invasive screening procedure. We believe that a radical eliminatory approach by means of combined surgery and IOE is indicated for the BRBNS to prevent ongoing gastrointestinal bleeding.
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Affiliation(s)
- Marcela Kopácová
- 2nd Department of Medicine, Charles University in Praha, Faculty of Medicine at Hradec Kralove, University Teaching Hospital, Sokolska 581, Hradec Kralove, 500 05, Czech Republic.
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Bhattacharjee K, Bhattacharjee H, Deka A. Acute progressive multiple cavernous hemangiomas of orbit in a child--a case report. Orbit 2007; 26:117-9. [PMID: 17613859 DOI: 10.1080/01676830600972781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Orbital cavernous hemangioma, a slowly progressive tumor of middle aged women is usually unilateral and solitary. We report a case of rapidly progressive multiple cavernous hemangiomas of the orbit in a young male patient.
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Kishikawa H, Okada Y, Kawahara T, Saito K, Tanaka Y. A case of blue rubber bleb nevus syndrome treated by etidronate. J Bone Miner Metab 2007; 25:138-41. [PMID: 17323184 DOI: 10.1007/s00774-006-0740-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 11/09/2006] [Indexed: 01/10/2023]
Affiliation(s)
- Hirofumi Kishikawa
- First Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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Limawararut V, Davis G, Crompton J, Leibovitch I, Selva D. Recurrent multiple cavernous hemangiomas of the orbit in association with systemic tumors. Am J Ophthalmol 2006; 141:943-5. [PMID: 16678512 DOI: 10.1016/j.ajo.2005.11.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 11/20/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To report the clinical findings and management of multiple, recurrent cavernous hemangiomas of the orbit in a patient with concurrent liver involvement. DESIGN Interventional case report. METHODS An analysis of clinical findings, radiology and treatment was conducted with a literature review. RESULTS A 35-year-old woman with blurry vision and proptosis was found to have multiple cavernous hemangiomas of the orbit. The tumors were excised completely without complication, and the patient subsequently regained her vision. Fifteen years later, the patient had recurrent, multiple cavernous hemangiomas in the same orbit. Further investigations for vague back pain revealed a presumed cavernous hemangioma in the liver and a presumed schwannoma arising from the neural foramen of the spine at the level of T2 through T4. CONCLUSION Multiple cavernous hemangiomas may recur after complete excision and may exist with concurrent systemic tumors.
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Affiliation(s)
- Vanessa Limawararut
- Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia.
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Kashkouli MB, Imani M, Tarassoly K, Tarrasoly K, Kadivar M. Multiple Cavernous Hemangiomas Presenting as Orbital Apex Syndrome. Ophthalmic Plast Reconstr Surg 2005; 21:461-3. [PMID: 16304530 DOI: 10.1097/01.iop.0000180756.32324.c3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 41-year-old man presented with a 7-year history of gradually increasing right proptosis and a 2-year history of decreased vision and limited eye movements. Right proptosis (11 mm), limitation of movement in all gazes, anisocoria, and visual impairment implied orbital apex compression. Computed tomography showed several distinct lesions with mild delayed enhancement extending to the orbital apex. Through a lateral orbitotomy, 10 discrete hemangiomas were removed uneventfully. Histopathologic findings were consistent with cavernous hemangioma in all tumors removed. Proptosis resolved after surgery at 3 to 4 weeks. Visual acuity was unchanged (20/25), and eye movement significantly improved at last follow-up, 15 months after surgery.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Oculoplastic Service, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Abstract
CT and MR imaging are particularly important in the diagnostic investigation of patients with vascular disorders of the orbit. The improved image quality of CT and MR imaging, along with dynamic CT angiography, MR angiography, MR venography, and multiphase dynamic contrast CT/MR imaging, has proven useful to delineate as well as differentiate various orbital vascular lesions. This article presents the current classification of orbital vascular disorders and describes the CT/MR imaging characteristics of orbital cavernous hemangiomas and simulating lesions.
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Affiliation(s)
- Sameer A Ansari
- Department of Radiology, University of Illinois Hospital at Chicago, University of Illinois College of Medicine, 1801 West Taylor Street, MC 711, Chicago, IL 60612, USA
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Apak H, Celkan T, Ozkan A, Yildiz I, Aydemir EH, Ozdil S, Kuruoglu S. Blue rubber bleb nevus syndrome associated with consumption coagulopathy: treatment with interferon. Dermatology 2004; 208:345-8. [PMID: 15178920 DOI: 10.1159/000077846] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2002] [Accepted: 01/08/2004] [Indexed: 11/19/2022] Open
Abstract
The blue rubber bleb nevus syndrome (BRBNS) is a rare vascular malformation syndrome with cutaneous and visceral lesions frequently associated with serious, even fatal bleeding. No systemic therapy is currently available. We report here a case with disseminated skin and gastrointestinal venous malformations and findings of disseminated intravascular coagulation that was treated with interferon beta. The disseminated intravascular coagulation manifestations were cleared with the treatment. The regression of the coagulopathy in our patient led us to think that the use of interferon beta in BRBNS might be beneficial.
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Affiliation(s)
- H Apak
- Pediatric Hematology-Oncology, Cerrahpasa Medical School, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
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