[Acute tumor of the lower eyelid caused by spontaneous hemorrhage of an occult vascular anomaly].

Purpose: To present an unusual acute tumour of the lid.

Patient: A 37-year-old female physician presented with a swelling and a slight hematoma of the right lower lid. Palpation revealed two firm painless nodules under an intact epidermis. The patient confirmed that the lesion had developed within only one day without a preceding trauma. Both eyes were morphologically and functionally normal. Motility was free, and there was no exophthalmus. After three weeks the palpable nodules had not changed substantially. Magnetic resonance imaging disclosed a space-occupying lesion resembling an old hemorrhage or an inflammation. Excision was performed which revealed a thrombus-like structure. Histology showed multiple endothelium-lined vessels that were densely filled with erythrocytes, hemorrhages within the connective tissue, and old hemosiderin deposits. However, no thrombus could be found.

Conclusion: Although thrombosis was the preferred diagnosis on clinical findings, histology led to the diagnosis of a spontaneous hemorrhage most likely caused by an occult vascular malformation.