[Analysis of clinical features in distensible orbital venous malformations].

Objective: To study the characteristic of the clinical and image features of distensible orbital venous malformations (DOVM).

Methods: It was a retrospective case series study. Clinical features and imaging findings, including B ultrasonography, CDFI, MRI, CT imaging of 43 patients with DOVM were reviewed in Shanghai Changzheng Hospital affiliated to Secondary Military Medical University

Results: Forty-three patients (24 women and 19 men), whose ages range from 5 to 71 years old, showed clinical or radiological evidence of distensibility. The mean age was 32 years. Location of the lesion within the orbit was variable, 9 patients with superficial lesions, and 19 patients with deep lesions. Twelve patients were classified as combined lesions. 3 patients with extraorbital venous malformations were classified as complex lesions. Twenty of 43 patients with DOVM were initially seen with proptosis or pain increasing with the head in a dependent position. Eight patients presented with a sudden onset of proptosis and pain secondary to thrombosis or hemorrhage. B ultrasonography showed an intermittently anechoic lesion that exhibits intrinsic flow during the Valsalva maneuver. Color Doppler imaging might demonstrate a reversal of flow toward the transducer during the Valsalva maneuver. Thirty-five of 43 cases with axial CT images showed a normal appearance or only mild enlargement of the involved veins, but coronal CT images could clearly demonstrate the lesion distensibility. Eight cases showed well defined tumor with homogeneous high density due to the thrombosis or hemorrhage within the orbit. MR imaging showed hypo to hyperintense signal on T(1)-weighted images, had hyperintense signal on T(2)-weighted MR images. However, signal of lesions of orbital hemorrhage could be various according to the different hemorrhage time.

Conclusion: DOVM usually occurs in young patients. Clinical diagnosis can be established with the typical symptoms and one or more imaging examinations.