eMedicine Specialties > Ophthalmology > Orbit

Hemangioma, Capillary: Differential Diagnoses & Workup

Author: Stuart Seiff, MD, FACS, Emeritus Professor of Ophthalmology, University of California San Francisco; Chief, Department of Ophthalmology, San Francisco General Hospital; Consultant, Oculofacial and Aesthetic Plastic Surgery, California Pacific Medical Center and Mills Peninsula Medical Center
Coauthor(s): Orin M Zwick, MD, Oculoplastic Surgeon, Chesapeake Eye Care and Laser Center; Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto; Susan Carter, MD, Clinical Associate Professor of Ophthalmology, Institute of Ophthalmology and Visual Science, New Jersey Medical School
Contributor Information and Disclosures

Updated: Jun 18, 2009

Differential Diagnoses

Hemangioma, Cavernous

Other Problems to Be Considered

Rhabdomyosarcoma
Lymphangioma
Neuroblastoma
Arterial venous malformations

Workup

Laboratory Studies

  • Immunohistochemical staining is positive for factor VIII.

Imaging Studies

  • Neuroimaging studies can be of great assistance in establishing the diagnosis.
  • Ultrasonography shows a lesion with irregular contour and low-to-medium internal reflectivity.
  • CT scan reveals a poorly circumscribed mass with no bony erosion. The lesion usually enhances with intravenous contrast.
  • Magnetic resonance imaging (MRI) reveals a lesion that is hypointense to fat on T1-weighted scans and hyperintense to fat on T2-weighted scans.
  • A well-circumscribed lobular pattern with prolonged parenchymal staining is seen with angiography. Involuting lesions tend to have less tissue staining.

Histologic Findings

Pathological findings include proliferation of a single layer of endothelial cells and pericytes. Endothelial cells of the basement membrane characteristically have large amounts of endoplasmic reticulum. The small vascular spaces lead to the formation of a high-flow lesion.

More on Hemangioma, Capillary

Overview: Hemangioma, Capillary
Differential Diagnoses & Workup: Hemangioma, Capillary
Treatment & Medication: Hemangioma, Capillary
Follow-up: Hemangioma, Capillary
References
[ CLOSE WINDOW ]

References

  1. Haik BG, Karcioglu ZA, Gordon RA, et al. Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol. Mar-Apr 1994;38(5):399-426. [Medline].

  2. Rosca TI, Pop MI, Curca M, et al. Vascular tumors in the orbit--capillary and cavernous hemangiomas. Ann Diagn Pathol. Feb 2006;10(1):13-19. [Medline].

  3. Kavanagh EC, Heran MK, Peleg A, et al. Imaging of the natural history of an orbital capillary hemangioma. Orbit. Mar 2006;25(1):69-72. [Medline].

  4. Weiss AH, Kelly JP. Reappraisal of astigmatism induced by periocular capillary hemangioma and treatment with intralesional corticosteroid injection. Ophthalmology. Feb 2008;115(2):390-397.e1. [Medline].

  5. Goggin M. Astigmatism and periocular hemangioma. Ophthalmology. Oct 2008;115(10):1854-5; author reply 1855. [Medline].

  6. Wittenberg L, Ma P. Treatment of a von Hippel-Lindau retinal capillary hemangioma with photodynamic therapy. Can J Ophthalmol. Oct 2008;43(5):605-6. [Medline].

  7. Assaf A, Nasr A, Johnson T. Corticosteroids in the management of adnexal hemangiomas in infancy and childhood. Ann Ophthalmol. Jan 1992;24(1):12-8. [Medline].

  8. Boon LM, MacDonald DM, Mulliken JB. Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg. Nov 1999;104(6):1616-23. [Medline].

  9. Cruz OA, Zarnegar SR, Myers SE. Treatment of periocular capillary hemangioma with topical clobetasol propionate. Ophthalmology. Dec 1995;102(12):2012-5. [Medline].

  10. Elsas FJ, Lewis AR. Topical treatment of periocular capillary hemangioma. J Pediatr Ophthalmol Strabismus. May-Jun 1994;31(3):153-6. [Medline].

  11. Kushner BJ. Intralesional corticosteroid injection for infantile adnexal hemangioma. Am J Ophthalmol. Apr 1982;93(4):496-506. [Medline].

  12. O'Keefe M, Lanigan B, Byrne SA. Capillary haemangioma of the eyelids and orbit: a clinical review of the safety and efficacy of intralesional steroid. Acta Ophthalmol Scand. Jun 2003;81(3):294-8. [Medline].

  13. Friling R, Axer-Siegel R, Ben-Amitai D, et al. Intralesional and sub-Tenon's infusion of corticosteroids for treatment of refractory periorbital and orbital capillary haemangioma. Eye. Nov 7 2008;[Medline].

  14. Shorr N, Seiff SR. Central retinal artery occlusion associated with periocular corticosteroid injection for juvenile hemangioma. Ophthalmic Surg. Apr 1986;17(4):229-31. [Medline].

  15. Weiss AH. Adrenal suppression after corticosteroid injection of periocular hemangiomas. Am J Ophthalmol. May 15 1989;107(5):518-22. [Medline].

  16. Deboer MD, Boston BA. Failure-to-thrive in an infant following injection of capillary hemangioma with triamcinolone acetonide. Clin Pediatr (Phila). Apr 2008;47(3):296-9. [Medline].

  17. Barlow CF, Priebe CJ, Mulliken JB, et al. Spastic diplegia as a complication of interferon Alfa-2a treatment of hemangiomas of infancy. J Pediatr. Mar 1998;132(3 Pt 1):527-30. [Medline].

  18. Deans RM, Harris GJ, Kivlin JD. Surgical dissection of capillary hemangiomas. An alternative to intralesional corticosteroids. Arch Ophthalmol. Dec 1992;110(12):1743-7. [Medline].

  19. Slaughter K, Sullivan T, Boulton J, et al. Early surgical intervention as definitive treatment for ocular adnexal capillary haemangioma. Clin Experiment Ophthalmol. Oct 2003;31(5):418-23. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

capillary hemangioma, capillary hemangiomas, orbital tumor, benign endothelial cell neoplasm, vascular malformation, vascular anomaly

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Stuart Seiff, MD, FACS, Emeritus Professor of Ophthalmology, University of California San Francisco; Chief, Department of Ophthalmology, San Francisco General Hospital; Consultant, Oculofacial and Aesthetic Plastic Surgery, California Pacific Medical Center and Mills Peninsula Medical Center
Stuart Seiff, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Orin M Zwick, MD, Oculoplastic Surgeon, Chesapeake Eye Care and Laser Center
Orin M Zwick, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Dan D DeAngelis, MD, FRCS(C), Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto
Dan D DeAngelis, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, California Medical Association, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Susan Carter, MD, Clinical Associate Professor of Ophthalmology, Institute of Ophthalmology and Visual Science, New Jersey Medical School
Susan Carter, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.