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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