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Cavernous hemangioma (more accurately termed cavernous venous malformation) is a benign, slow-growing vascular lesion and the most common primary orbital tumor in adults.
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It typically arises within the intraconal space and presents as a painless, progressive proptosis in middle-aged adults.
| Feature | Description |
|---|---|
| Nature | Vascular malformation composed of dilated, endothelium-lined sinusoidal vessels |
| Growth pattern | Slowly enlarging; may expand with Valsalva or hormonal changes |
| Histology | Encapsulated lesion with blood-filled vascular spaces; lacks true arterial components |
| Characteristic | Note |
|---|---|
| Age | Most common between 30–60 years |
| Sex | Slight female predominance |
| Location | Intraconal space (especially lateral or inferior quadrant of orbit) |
| Feature | Description |
|---|---|
| Painless progressive proptosis | Most common presentation |
| Globe displacement | Depends on lesion location (usually inferomedial) |
| Diplopia | Due to mass effect on extraocular muscles |
| Visual disturbances | May occur due to optic nerve compression |
| Intermittent symptoms | Rarely, due to hemorrhage or increased venous pressure |
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A well-circumscribed, intraconal, high T2 signal mass with progressive enhancement is highly characteristic.
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| Modality | Imaging features |
|---|---|
| CT | • Well-defined, ovoid mass, often lateral intraconal in location |
| • Iso- to hyperdense relative to muscle | |
| • Homogeneous post-contrast enhancement | |
| • No calcification or fat: Helps differentiate from dermoid/other lesions | |
| • Chronic lesions: Smooth bony remodeling without destruction | |
| MR | • T1: Iso- to mildly hyperintense compared to muscle |
| • T2: Markedly hyperintense (blood-filled spaces) | |
| • Post-contrast T1: |
◦ Progressive “fill-in” enhancement (**centripetal pattern**)
◦ May be homogeneous in delayed phase
• DWI/ADC: No restricted diffusion |
CVM in a 43-year-old man who presented with right proptosis. (A) Axial fat-saturated T2-weighted MR image shows a well-circumscribed intraconal lateral retrobulbar mass (arrow) with high signal intensity and a peripheral low signal intensity capsule, resulting in anterior displacement of the globe. (B) Axial early-phase gadolinium-enhanced fat-saturated T1-weighted MR image 120 seconds following contrast administration shows mild central enhancement (arrow). (C) Axial delayed phase MR image 390 seconds following contrast administration shows progressive filling enhancement (arrow).
Naves GG, De Oliveira Cabral HJ, De Oliveira HR, Scoppetta TLPD, Zuppani HB, Assunção FB. Practical approach to orbital lesions by anatomic compartments. Radiographics. 2024;44(10). doi:10.1148/rg.240026
Orbital hemangioma as seen on CT in two different patients. a. Coronal NECT in a 30-year-old male patient shows a well-circumscribed intraconal mass (arrow) with calcified phleboliths. b-d. 50-year-old male patient with an incidentally diagnosed left orbital cavernous hemangioma on an angio-CT performed for stroke. b. NCECT shows a nonspecific intraconal lesion (arrow) without phleboliths. Arterial phase (c) demonstrates initial patchy enhancement (arrow) followed by progressive filling of the lesion in the venous phase (d)
Purohit, B.S., Vargas, M.I., Ailianou, A. et al. Orbital tumours and tumour-like lesions: exploring the armamentarium of multiparametric imaging. Insights Imaging 7, 43–68 (2016). https://doi.org/10.1007/s13244-015-0443-8