A 51 year old gentleman, with history of right eye proptosis since 15 days

A 51 year old gentleman, with history of right eye proptosis since 15 days

A 51 year old gentleman, with history of right eye proptosis since 15 days.

  • Axial T2 weighted image demonstrates a fairly-defined, multiloculated heterogeneously T2 hyperintense lesion involving the intraconal and extraconal compartments of the right orbit. Axial T1 weighted images demonstrate multiple small cystic spaces within the lesion with heterogeneously hyper-intense contents suggestive of hemorrhagic, lymphatic, or proteinaceous content.
  • Axial T2 fat-suppressed images demonstrate fluid-fluid levels with hypointense-dependent contents within the lesion. Coronal T2 fat-suppressed images demonstrate a hypointense pseudo capsule.
  • Post-contrast T1 axial and coronal sequences demonstrate mild heterogenous enhancement of the lesion.
  • Sagittal T2 and T1 sequences demonstrate multiple hypointense foci within the lesion. These correspond to hyperdense calcific foci on CT and are suggestive of phleboliths.


Orbital slow flow venous malformation.



  • Also known as orbital cavernous venous malformations, these are the most common?vascular lesions of the orbits in adults.
  • ?Usually presentwith a slowly growing orbital mass resulting in proptosis



  • Most commonly located within the intra conal compartment, on the lateral aspect?.
  • Usually round or oval.
  • USG: Smoothly circumscribed retrobulbar lesion with regular moderate to high internal echogenicity and no demonstrable internal vascularity.
  • CT: Well-circumscribed, rounded or oval soft tissue density mass, which gradually and incompletely fills in following the administration of contrast. Phleboliths can be seen.
  • MRI:

T1Isointense compared to muscle. If areas of thrombosis are present, then hyperintense regions may be visible.

T2Hyperintense compared to muscle. Can have fluid-fluid levels with T2 hypointense pseudo capsule and T2 hypo intense phleboliths.

T1 C+ (Gd):??Slow gradual irregular enhancement with delayed washout.


Differential diagnosis: 

  1. Orbital venous varix: Typically located at the orbital apex. Increase in size during Valsalva’s manoeuvre.
  2. Orbital hemangiopericytoma: Typically, extra conal. Marked arterial phase hyper enhancement, with early venous phase enhancement and rapid washout.
  3. Orbital schwannoma: Usually extra conal in the superior orbit. Has a cone shape if orbital apex is involved and dumbbell shape if superior orbital fissure is involved.
  4. Orbital lymphoma: Usually superotemporal orbit. Usually homogenously enhancing mass which molds to the orbit and globe.

Dr. Rosmi Hassan Karuvath,
Radiology Resident,
Manipal Hospitals Radiology Group.

Dr. Anita Nagadi,
Lead Head & Neck, Oncology
Senior Consultant Radiologist
Manipal Hospitals Radiology Group.