以自发性出血为特征的眼眶静脉畸形临床分析

目的 探讨眼眶静脉畸形伴自发性出血的临床、影像学特征、诊断和治疗原则.方法 对15例单眼眼眶静脉畸形伴自发性出血的病例进行回顾性分析.结果 所有患者中,除1例Valsalva试验出现眼球突出度增加外,余均无扩张性病变临床征象.15例患者均行眼眶CT检查,6例误诊为肿瘤,其中5例均经MRI明确为出血.7例行保守治疗,出血吸收后,影像学随访发现扩张性静脉畸形.8例行手术治疗,2例病理提示为混合型静脉淋巴管瘤,6例为静脉性血管畸形,术后6例视力获得提高.结论 与全身静脉系统联系较少的眼眶静脉畸形,临床上常无特征性表现,一旦发生眶内出血易误诊为肿瘤.对不明原因的急性眼球突出伴眼眶胀痛,眼眶MRI常可发现出血性病变,无明显视力下降时可予保守治疗,待出血吸收后影像学随访检查常可发现扩张畸形的血管病变.视力显著下降的患者,应行手术干预,多可获得视力恢复.

Abstract：

Objective To approach the clinical and image features,diagnosis and treatment of orbital venous malformations(OVMs)presenting with spontaneous hemorrhage.Methods A retrospective review of 15 patients with OVMS presenting with spontaneous hemorrhage.Results None of all the patients showed clinically distensibility except 1 observed worsening proptosis with Valsalva maneuver.CT scan were done in all patients.6 were referred with a suspicion of orbital tumor,5 of them were identified orbital hemorrhage by typical findings on MRI.7 patients were treated conservatively.After resolution of the hemorrhage,they evidenced a distensible OVMs in a follow-up imaging study.8 patients were treated by surgical excision and were all examined histopathologically.2 of them were confirmed venous-lymphatic malformations,6 were confirmed OVMs.Visual acuity was improved in 6 patients.Conclusions OVMs with small venous connection may be not clinically evident.Spontaneous hemorrhage develops in this lesion can simulate orbital tumors.In cases that show acute exophthalmos and ocular pain,MRI should be used to verify the hemorrhage.It is better to wait,with conservative treatment when one without visual deterioration,until the hemorrhage is resolved and then performed a follow-up CT for the diagnosis.Surgical intervention should be confirmed to those with visual deterioratinn.Most of them can get visual recovery.

Analysis of clinical features in orbital venous malformations presenting with spontaneous hemorrhage

Objective To approach the clinical and image features,diagnosis and treatment of orbital venous malformations(OVMs)presenting with spontaneous hemorrhage.Methods A retrospective review of 15 patients with OVMS presenting with spontaneous hemorrhage.Results None of all the patients showed clinically distensibility except 1 observed worsening proptosis with Valsalva maneuver.CT scan were done in all patients.6 were referred with a suspicion of orbital tumor,5 of them were identified orbital hemorrhage by typical findings on MRI.7 patients were treated conservatively.After resolution of the hemorrhage,they evidenced a distensible OVMs in a follow-up imaging study.8 patients were treated by surgical excision and were all examined histopathologically.2 of them were confirmed venous-lymphatic malformations,6 were confirmed OVMs.Visual acuity was improved in 6 patients.Conclusions OVMs with small venous connection may be not clinically evident.Spontaneous hemorrhage develops in this lesion can simulate orbital tumors.In cases that show acute exophthalmos and ocular pain,MRI should be used to verify the hemorrhage.It is better to wait,with conservative treatment when one without visual deterioration,until the hemorrhage is resolved and then performed a follow-up CT for the diagnosis.Surgical intervention should be confirmed to those with visual deterioratinn.Most of them can get visual recovery.