1. PATIENT PRESENTATION
A 22‐year‐old pregnant woman with no significant past medical history presented to the emergency department (ED) after she awoke with a severe right‐sided retro‐orbital headache and right‐sided proptosis. Physical examination, including neurologic examination, was unremarkable, with the exception of moderate right‐sided proptosis. She had no visual changes and extra‐ocular movements were painful, but intact. She was in the 28th week of her first pregnancy, which was previously uncomplicated. A head computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed that demonstrated a 1‐cm retro‐orbital mass (Figure 1). Ophthalmology was consulted.
FIGURE 1.
MRI demonstrating orbital cavernous hemangioma (arrow)
2. DIAGNOSIS
2.1. Orbital cavernous hemangioma
3. DISCUSSION
Orbital cavernous hemangioma is a benign vascular malformation and is the most common primary orbital lesion in adults. 1 They are usually unilateral, more common in women, and gradual progressive proptosis is the presenting sign/symptom 70% of the time. 1 Acute presentation, attributed to intralesional hemorrhage, is extremely rare with only 9 cases reported in the literature to date. 2 There is some evidence to suggest that female hormones, including pregnancy‐related growth factors, play a role in the growth of these vascular malformations. 1 , 3 Both CT scan and MRI are useful in identifying these lesions and should be performed with contrast to appreciate filling characteristics. 1
Given the abrupt onset of our patient's symptoms, there was concern for further evolution of the lesion. She was admitted to the hospital overnight for frequent re‐evaluations by ophthalmology, monitoring for signs of orbital compartment syndrome with a plan for lateral canthotomy should they arise. She was discharged with outpatient ophthalmology follow‐up, with discussion of definitive surgical management being deferred until the post‐partum period.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Ufkes P, Lewis N, Foster C. Pregnant woman with proptosis. JACEP Open. 2021;2:e12340 10.1002/emp2.12340
REFERENCES
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