PMC7603845_01
MIP reformatted images from contrast-enhanced gadolinium 3D MPRAGE sequences, on coronal (A), axial (B) and coronal-oblique (C) planes; axial FLAIR (D, E) and axial GRE T2* (F) images which show three intracranial DVAs of the left hemisphere: a parieto-occipital DVA with deep drainage (A); a DVA with two drainages in the perimesencephalic cistern and in the middle cranial fossa (B), with FLAIR hyperintense signals which suggests gliosis (D, E); a DVA in the fronto-insular region (C), with deep drainage in the vein of Galen; and a cavernous hemangioma in the subcortical occipital lobe.
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F1
Three months later, Magnetic Resonance Imaging (MRI) examination of the brain and the orbits, without and with the administration of Gadolinium-Based Contrast Agent (GBCA), showed the presence of three venous developmental abnormalities located in the left hemisphere (Fig. 1). A sharply hypointense area in the Gradient Echo (GRE) T2* sequence of the subcortical white matter of the left occipital lobe was related to a cavernous hemangioma with haemosiderin deposits (Fig. 1).
MIP coronal T2 fat-suppressed (A), and coronal (B) and sagittal (C) contrast-enhanced 3D MPRAGE reformatted images. Coronal T2 fat-suppressed (D, E) and axial FLAIR (F) images. Note a left inhomogeneous T2 hyperintense intra-orbital medial mass, consistent with a slow flow venous-lymphatic congenital anomaly (straight arrow in A, D), that was clinically visible as a lump of the left medial canthus. A bone hemangioma at the roof of the left orbit (straight arrow in B, C, E, F), sub-cutaneous fluid retention in the left frontal scalp (curved arrow in B, E) and thickening of the subcutaneous tissues in the left fronto-nasal skin (curved arrow in C, F).
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F2
In the left intra-orbital space, at the level of the clinically visible lump of the left medial canthus (Fig. 2, straight arrow in A and D), we observed a T2 hyperintense cystic irregular mass, with peripheral contrast enhancement after gadolinium administration. Moreover, swelling and subcutaneous fluid retention were present in the left frontal side of the scalp (Fig. 2), both findings suggesting a slow-flow mixed venous-lymphatic vascular malformation. A bone hemangioma was detected in the roof of the left orbit (Fig. 2).