1. Head and Neck Imaging.
Ehab Abo-Ulfotouh Helal.
Lecture Of Radio-Diagnosis.

2.  Mass effect on the orbits can lead to clinical
presentations such as:
- Proptosis, pulsatile or non.
- Orbital pain
- Visual loss.
- Diplopia.
- Bruit.

3.  Can alter the normal orbital blood flow pattern.
 Lead to vascular engorgement.

4.  Also known as benign hemangioendothelioma.
 Most common orbital vascular tumor in infants.
 Entirely extra-conal in location or have a
substantial extra-conal component.
 superficial or deep, commonly extend across tissue
planes, and may extend intra-cranially through the
optic canal or superior orbital fissure.

5.  Extraocular muscles and lacrimal glands
occasionally are involved.
 Capillary hemangiomas may cause proptosis,
globe displacement, and, occasionally, amblyopia.
 expand slightly during crying or straining.
 isolated findings or may be found in association
with other manifestations in various syndromes
(PHACE)

7. Capillary
Hemangiomas.
Computed tomography
(CT) feature.
Non-encapsulated.
Lobulated , irregularly
marginated.
Heterogeneous.
Intense homogeneous
Enhancement.

8. Capillary
Hemangiomas.
At MR Imaging:
Hypointense on
T1-weighted images.
Iso- to hyper-intense
Lobules with thin septa,
combined with intra-
lesional and peri-lesional
flow voids, characteristic
features on T2-weighted
images.
Intense enhancement.

10.  Also known as cavernous hemangiomas.
 Most common vascular lesions in adults.
 Manifest with progressive, painless proptosis.
 Less common symptoms include pain, lid swelling,
diplopia, a palpable lump, and recurrent episodes of
obscured vision.
 Nature of cavernous malformations:
- Venous origin.
- low-flow arterio-venous malformations.

11.  Solitary, capsulated.
 Retrobulbar intra-conal space.
 Extend intra-cranially through the superior
orbital fissure (5%–10%).
 Associations with Maffucci syndrome and blue
rubber bleb nevus syndrome.

12. Cavernous
Malformations.
On NECT images.
Well circumscribed.
Round or ovoid.
Homogeneously
Hyper-attenuating, intra-
conal lesions.
Contain micro-
calcifications.
May produce expansion
of orbital walls.

13. Cavernous
Malformations.
Displace adjacent
structures but do not
invade them.
On enhanced CT:
Poor enhancement
noted in early arterial
phase.
Fill central
part of the lesion on late
venous phase.

14. Cavernous
Malformations.
At MR imaging.
Isointense to that of
muscle on T1-weighted
images.
Hyperintense to that of
muscle on T2-weighted
images.
Internal septa are visible
within larger lesions.
Progressive accumulation
of contrast material on
late phase delayed
images.

16.  Term lymphangioma commonly applied to this
lesion.
 Referred to as no-flow or low-flow vascular
malformations.
 Evident at birth, but generally manifest in infancy
or childhood.
 Slowly progressive proptosis, restriction of eye
movements, or vertical globe displacement, many
manifest abruptly because of hemorrhage.

17.  Diffuse un-encapsulated.
 Multi-compartmental, often including both
intraconal and extraconal components .
 Extend across tissue planes, infiltrate the eyelid
and orbit, and cause bone remodeling.
 isolated from normal orbital vasculature.
 Not affected by postural changes.

18. Venous Lymphatic
Malformations.
MR imaging is the
modality of choice.
Signal intensity of the
lesions depends on type
of fluid within the cystic
components ( T1WIs, Fat
supp., T2WIs).
Fluid-fluid levels within
multiple cysts.
Variable
enhancement.