A 4-week-old boy was referred to our dermatology unit
for evaluation of a left lower lid mass which was present
since birth. Physical examination revealed a large, nonpulsatile
mass in the left infra-orbital region, with bluish
discolouration of the overlying skin. In the first 2 months
after birth, the mass was noted to show reduction in size,
prompting the diagnosis of a rapidly involuting congenital
hemangioma (RICH). However, at 5 months of age, the
mass showed interval increase in size. In addition, there
was increased bluish discolouration of the overlying skin.
In view of the unexpected clinical course, further imaging
was performed. Ultrasound of the left orbit revealed a well
defined, heterogenous soft tissue mass in the medial aspect
of the lower eyelid. Minimal internal vascularity was noted
on Doppler interrogation (Figs. 1A-1B). Magnetic resonance
imaging (MRI) confirmed the presence of a mildly enhancing
heterogenous soft tissue mass, confined within the inferior
extra-conal compartment of the left orbit. A small cystic area
was seen within its medial aspect but no definite fluid-fluid
level or fat was seen. There were also no apparent signal
voids on T1-weighted and T2-weighted images to suggest
the presence of calcifications. No intracranial extension
was demonstrated (Figs. 1C-1E).
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