Orbital venous hemangioma

Introduction to orbital venous hemangioma Internal iliac hemangioma is different from those occurring in other parts. The venous diameter is small and there are many fibrous tissues. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: varicose veins

Causes of orbital venous hemangioma

(1) Causes of the disease

The etiology of venous hemangioma is unknown. Because it occurs mostly in childhood, the composition of the tumor is complicated. In addition to the vein, it is often accompanied by capillaries. The fibrous tissue is rich. Some scholars believe that it is developed from capillary hemangioma. In some patients, capillary hemangioma spontaneously subsides during the growth of the human body. About 25% of patients have more fibrosis, and the capillary hemangioma is incompletely degenerated, and it develops into a larger vein, forming a vascular fibrous tissue mass, but this hemangioma Often more frequent, more common in the eyelids, head and neck and oral mucosa, there are cases of tumors found at birth or shortly after birth, and thus may be a hamartoma formed by abnormal proliferation of blood vessels in late postpartum or after birth.

(two) pathogenesis

It is not yet very clear.

Orbital venous hemangioma prevention

There are generally no special precautions.

Orbital venous hemangioma complications Complications varicose veins

Similar lesions can be found in the subcutaneous or submucosal tissues of other parts of the body, such as the buccal submucosa or hard mucosa of the oral cavity, the deep cheeks and the frontal sac, etc., and the lesions are plexiform venous masses or large and distorted dilated venous cavities. .

Symptoms of orbital venous hemangioma Common symptoms Choroidal depression fundus changes eyeball displacement hematoma formation varicose optic atrophy diplopia intrahepatic hemorrhage

The age of venous hemangioma is more in children and youth, and it is later than that of capillary hemangioma. It is earlier than cavernous hemangioma. The ocular manifestations are mostly ocular protrusions, which are chronic progressive. Because the lesions are mostly located in the upper quadrant of the iliac crest, The eyeball protrudes and shifts outward and downward (Fig. 1). The eyeball protrudes to a certain degree of position. When the head is pressed or the internal jugular vein is pressed, the eyeball is more prominent. Although the eyeball is less prominent when standing, it is still raised than the contralateral eye. The point is similar to capillary hemangioma, which is different from cavernous hemangioma, which is different from orthostatic, and is different from varicose veins. The varicose veins are invaginated when the patient is varicose, the eyeball is protruding when the head is down, and the venous hemangioma is sometimes The degree of eyeball abruptly increases, and even the eyeball is prolapsed and cleft, accompanied by conjunctival edema and congestion.

This is due to intratumoral hemorrhage, or the role of the piston of thrombosis, accumulating a large amount of blood when it is completely blocked. This sudden increase in the eyeball is gradually relieved, accompanied by subcutaneous or subconjunctival congestion, and venous hemangioma often repeats. Bleeding, which is often the main reason for patients to see a doctor, thrombosis has occurred many times, X-ray and CT tracking can be seen to increase the number of venous stones, the initial stage of the disease, can also show intermittent eyeball protrusion, that is, after the ball bleeding, before the eye Long, after the blood is absorbed and absorbed, the eyeball is reset, and then gradually develops into a one-sided eyeball. The ankle and mass are the second common clinical signs, mostly located in the upper quadrant of the iliac crest. The surface of the mass is smooth or uneven, moderately hard or soft, no tenderness, can be pressed into the sputum, and the mass is increased when the head is lowered. Large, the surface can be purple-blue, the tumor can be reduced when pressed, and the tumor of the older patient can be found in the lower part of the iliac crest.

However, almost all of the tumors can be found in the upper quadrant of the eyelids during surgery. If the tumor cannot be rubbed and the tumor is pressed, the eyeball is pressed into the eyeball with a thumb, and there is resistance behind the ball, but it has less resistance than the cavernous hemangioma and lacks elasticity. In childhood, the visual acuity of patients can not be expressed, and the general visual acuity is not affected. This is because the tumor not only oppresses the eyeball, but also affects the optic nerve. When the bleeding occurs, the acute pressure is increased, the vision is reduced, the hemorrhage is formed at the tip of the ankle, and the vision loss can also be caused. If there is more blood or blood clots, oppression of the optic nerve, vision loss can be completely lost, vision loss can occur immediately or within a few hours after the bleeding, the visual loss caused by such bleeding needs to be dealt with in a timely manner, otherwise it will be permanently blind, should be Under ultrasound guidance, puncture and aspiration, blood is sucked out, reducing the pressure of the tip of the fistula, such as insufficient suction, continue to bleed, or has become a blood clot, vision is not restored, emergency surgery, clearing blood clots, stopping bleeding, placing drainage strips, Some patients in the emergency room rapidly decreased vision to black Mongolian, ultrasound found the hemorrhoids in the tip of the sacral heel, although the puncture up to 3ml, the vision did not recover; some patients had visual acuity after treatment for several hours, in ultrasound guided puncture No blood was drawn, that is, the lateral opening was performed, and purple blood clots were found on the outside of the optic nerve at the tip of the sacral sac, with a curette removed, and compression to stop bleeding. Partial recovery of vision, bleeding in the anterior and middle eyelids, although it can cause temporary vision loss, there is little black Mongolian, and the hematoma of the tip of the eye may cause permanent vision loss.

Intraorbital venous hemangioma occurs either in the anterior or anterior part of the iliac crest, or in the anterior part of the eye, and there are purple masses or red blood vessel masses under the eyelids and conjunctiva. It is found that the conjunctiva is located above the medial or medial conjunctiva of the inferior vault. When the eyelids are turned over, the blue-purple bumps are visible, the compression is reduced, and the ipsilateral internal jugular vein is compressed. The abnormal blood vessels on the surface of the sclera rapidly expand to form a flaky or saclike shape. After the compression is relieved, the blood vessels are retracted, and abnormal blood vessels are often found around the eyelids. Department, subcutaneous, can also invade the frontal bone, the occurrence of intraosseous hemangioma, with derived blood vessels, venous hemangioma can simply invade the eyelids and conjunctiva, histopathologically different from the sacral, with few fibrous tissue between the blood vessels The development of abnormal vascular infiltration can invade the entire layer of the eyelid, but does not cause eyeball protrusion and eyeball displacement.

Because venous hemangioma is mostly located in the anterior segment of the iliac crest, unless it directly invades the extraocular muscles, it usually does not cause diplopia and ocular dyskinesia in the early stage. If the tumor is large, the eyeball is insufficiently rotated in the direction of the lesion, and the hemangioma invades the extraocular muscle early. Fibrosis, causing strabismus and varying degrees of ocular dyskinesia, the internal rectus and superior rectus muscles are more common.

Examination of orbital venous hemangioma

1. Histopathological examination: On the operating table or the pathological specimen, the macroscopic examination is a non-enveloped purple-red mass, which is widely adhered to the surrounding muscles and optic nerve, and even invades the extraocular muscles, and the fibrous cord extends into the fat. The typical shape has a large front end and a small rear end. There are a few veins connected to the tip of the sputum. The tumor has a large purple-black blood chamber. This blood chamber can have multiple, and does not communicate with each other. It is purple grape-like and swollen. The blood supply and drainage vessels are all veins, blood flow is slow, and thrombus is easy to occur. The specimens can be seen with purple-black blood stasis and venous stones. The microscopic examination has no capsule. The tumors are mainly composed of veins with different diameters. The fibrous tissue of the piece is composed of different thicknesses of the venous wall, cystic enlargement of the lumen, sinus shape in the thin-walled vascular area, and sometimes diagnosed as cavernous hemangioma. It is also often found that vascular endothelial cells accumulate with only a few capillaries. Therefore, some people think that this tumor is a spontaneously degenerating capillary hemangioma. The interstitial fibrosis is richer than that of cavernous hemangioma. The fibroblasts criss-cross and form the main body of the tumor. Sheet erythrocytes and lymphocytes, macrophages and foreign body into a piece of fat cells, the common edge striated muscle, striated muscle and fat mass may be increased due to blocking wrap or violations.

Internal iliac hemangioma often associated with lymphangioma, hemangiolyphangioma or angioma, lymphatic vessels mixed in or on one side of the hemangioma, transparent on the side of the purple hemangioma The cyst can be confirmed as a lymphangioma by microscopy.

2.X examination of the age of onset is small, the tibia is developing, the deep venous hemangioma often causes the enlargement of the lateral sacral volume. This expansion of the sacral cavity is non-specific, such as accompanied by venous stones for diagnosis. Great meaning.

3. Ultrasound exploration B-mode ultrasound exploration can find specific images, space-occupying lesions, irregular shape, unclear or non-smooth borders, and varying internal echoes. Multiple tubular or flaky anechoic areas can be seen. These anechoic areas , representing the expansion of the vein or mass in the hematoma, the probe oppresses the eyeball, the pressure is transmitted to the tumor, the anechoic zone is not locked or deformed, the locked zone represents the dilated blood vessel, the deformed zone represents the hemorrhage, and the A-type ultrasound shows the peak between the high and low There is a small flat section, the flat section indicates the hematopoietic area. Doppler ultrasound exploration is due to the slow blood flow in the tumor blood vessels, which does not reach the display threshold, color Doppler can not show or less color blood flow; pulse Doppler does not appear peak The spectrum is parallel to the baseline and is expressed as venous blood flow, which is consistent with cavernous hemangioma.

4. CT scan CT shows that the tumor is more clear, the shape is not regular, the boundary is unclear or not smooth, the internal density is homogeneous or heterogeneous, the CT value is generally greater than +40HU, and the positive contrast agent is more obvious. About 1/4 of the cases have found single or multiple venous stones. It is often found that the lesions extend along the wall of the eye. If there is bleeding, the density of the tumor and the wall of the eyeball is close, showing a cast appearance, and the tumor can spread backwards. The cranial fossa is concave, but the CT plain film is difficult to display. It can be found after contrast agent enhancement. The secondary changes of the tumor are common enlargement of the sacral cavity and prominent eyeball.

5. MRI MRI showed that the location, shape, boundary and extent of the tumor were the same as CT, T1WI signal intensity was medium, lower than intraorbital fat, close to extraocular muscle and optic nerve, T2WI signal intensity increased, high signal, higher than In the intraorbital fat, intracranial spread, MRl can show the spread path, the location and extent of the lesion in the skull, this point MRI is significantly better than ultrasound and CT, the hemorrhage in the tumor after 72h hemoglobin is separated from the ferric iron, there is a smooth Magnetic action, high signal intensity in both the T1 and T2WI areas of the hemorrhage.

Diagnosis and differentiation of orbital venous hemangioma

Diagnostic criteria

Venous hemangioma is soft in texture. Although it contacts the eyeball or optic nerve, it rarely causes changes in the fundus. If there is bleeding, optic disc edema can occur in the optic nerve before compression, oppression of the posterior optic nerve causes primary optic atrophy, and high optic bulge is also common in the optic nerve. Atrophy, accompanied by vision loss. Because of its obvious age tendency, it occurs mostly in childhood, has a history of repeated bleeding, sputum and soft masses and conjunctiva, orbital and head and neck hemangioma, diagnosis is not difficult, but occurs in the deep examination of the sputum It is difficult to determine the correct diagnosis, because the causes of eyeballs protruding during childhood are diverse.

Differential diagnosis

Clinically and ultrasonically, it is similar to lymphangioma. Sometimes the lesion suddenly bleeds, which may cause the eyeball to aggravate. It is easy to be misdiagnosed as a malignant tumor. Some lesions are mildly orthostatic, which is difficult to distinguish between clinical and imaging and varicose veins.

Internal iliac hemangioma sometimes develops rapidly, especially when intratumoral hemorrhage, eyeball protrusion can suddenly increase, should be differentiated from rhabdomyosarcoma and inflammatory pseudotumor occurring in childhood, both of which are hypoechoic Sexually, there is no lumen-like anechoic area, Doppler ultrasound shows abundant color flow and arterial spectrum, while venous hemangioma can be seen in tubular anechoic area, and can be pressed and locked, with little or no color flow. , for the venous spectrum.

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