Short report
Recurrent proptotic diplopia due to congestive expansion of
cavernous haemangioma with relapsing right-sided cardiac failure
Denis O'Mahonya, Eamon O'Neillb
a Clinical
Investigation Unit, University Hospital Birmingham NHS Trust, Queen
Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK, b Department of Ophthalmology, Selly Oak
Hospital, Birmingham, UK
Accepted 17 March 1999
A 75-year-old man with a recent history of pulmonary embolism,
presented with collapse followed by a gran mal seizure and right-sided
non-pulsatile proptosis. On recovery, he had diplopia on lateral and
upward gaze and signs of congestive cardiac failure. Further pulmonary
embolism was proven by lung scintigraphy. Computed tomography of his
orbits confirmed a contrast-enhancing space-occupying lesion of the
medial wall of the right orbit, with no intracranial abnormality. The
patient was investigated for metastatic tumour as a possible cause of
the space-occupying lesion and the unprovoked thromboembolic event, but
no evidence of malignancy was found. The orbital lesion was not
biopsied because of the risk of bleeding from anticoagulation. Three
weeks later, the patient re-presented with recurrent cardiac failure,
proptosis, and diplopia. A transorbital ultrasound confirmed an
encapsulated, well-defined vascular lesion, with typical appearances
and Doppler flow characteristics of a cavernous haemangioma. Diuretic
therapy abolished the proptosis and diplopia in tandem with relief of
the cardiac failure. This is the first description of recurrent
proptosis with diplopia due to recurrent congestive expansion of an
orbital cavernous haemangioma.
Keywords: haemangioma; proptosis; diplopia; cardiac failure
© 1999 by The Fellowship of Postgraduate Medicine
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