PMC10051039_01
Coronal (a) and axial (b) CT scan of the head and orbits, soft tissue window, showing a well-circumscribed intraconal lesion with slight hypodensity of the inferior aspect of the lesion.
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F1
The patient had initially presented to an outside ED 1 week prior to our evaluation, where a noncontrast CT scan showed a bilobed retrobulbar mass causing proptosis, optic nerve impingement, and extraocular muscle impingement (Fig. 1).
T1-weighted MRI with contrast, coronal cut (a) and T2-weighted MRI with contrast, axial cut (b) and showing heterogeneous enhancement of a well-circumscribed intraconal lesion.
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F2
T1 and T2 hyperintensity superiorly and hypointensity inferiorly (Fig. 2). The decision was made to obtain a biopsy.
Intraoperative fluoroscopic angiography again showed no opacification of the malformation to indicate arterial involvement (a). The lesion underwent direct catheterization (b) and injection of Onyx (c), with only a small remnant of Onyx remaining after surgical excision (d).
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F3
The lesion was filled with Onyx under fluoroscopic guidance, and the lesion and Onyx were then removed without complication (Fig. 3).