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AJNR - American Journal of Neuroradiology

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Resection of an Orbital Lymphangioma with the Aid of an Intralesional Liquid Polymer

Amit D. Malhotra^a, Mona Parikh^b, Daniel C. Garibaldi^b, Shannath L. Merbs^b, Neil R. Miller^b and Kieran Murphy^a

^a Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD
^b Wilmer Eye Institute, Baltimore, MD

View larger version (63K): [in a new window]   FIG 1. Preoperative appearance of the patient demonstrates marked right proptosis and superior displacement of the globe. Also note enlarged right orbit compared with left orbit.

View larger version (79K): [in a new window]   FIG 2. Preoperative CT scan, axial view, bone window settings, demonstrates marked enlargement of the right orbit compared with the left orbit. Note large, multilobulated mass in the right orbit with thinning of lateral orbital wall.

View larger version (136K): [in a new window]   FIG 3. Preoperative MR imaging. A, Axial MR image obtained at the level of the mid orbit shows a multilobulated mass surrounding and superiorly displacing the right globe (G). B, Coronal MR image obtained in the plane of the left globe shows a large lesion occupying most of the right orbit. The right globe is so proptosed that it is not seen on this image.

View larger version (60K): [in a new window]   FIG 4. C-arm fluoroscopy performed after injection of 50% Ethiodol combined with 50% N-butyl-2-cyanoacrylate glue demonstrates complete filling of the first segment of the lymphangioma.

View larger version (69K): [in a new window]   FIG 5. Appearance of the patient 2 months postoperatively shows marked reduction in proptosis and displacement of globe.

View larger version (141K): [in a new window]   FIG 6. Postoperative MR imaging. A, Axial MR imaging at the level of the mid orbit obtained 2 months after surgery demonstrates significant reduction in the amount of the lesion. B, Coronal MR image, obtained in the same plane as Fig 3B, 2 months after surgery, shows that both globes are now seen and appear to be in the same relative position, indicating that the bulk of the mass has been resected.