Tsutsumi Satoshi, Higo Takuma, Kondo Akihide, Abe Yusuke, Yasumoto Yukimasa, Ito Masanori
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Neurol Med Chir (Tokyo). 2007 Jun;47(6):265-8. doi: 10.2176/nmc.47.265.
A 75-year-old male suffered sudden onset of retroorbital pain, visual loss, periorbital ecchymosis, and double vision without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection also revealed marked restriction of the extraocular movements, visual defect, and exophthalmos on the affected side. Neuroimaging showed an irregular-shaped retrobulbar mass centered in the inferolateral aspect and partially protruding between the inferior and lateral rectus muscles without enhancement by contrast medium. High dose steroid therapy provided little improvement in the visual symptoms. Needle aspiration biopsy revealed only fluid hematoma. Surgical exploration via the lateral wall of the orbit resulted in escape of chocolate-colored, liquefied hematoma during dissection between the inferior and lateral rectus muscles. No obvious vascular lesion was recognized. A small purplish elastic soft mass with irregular contours was recognized adherent to the inferior rectus muscle within the capsule of the hematoma. The mass was subtotally resected. The histological diagnosis was inflammatory pseudotumor with hemorrhagic change. No component of vascular malformation was found. Visual function and extraocular movement improved postoperatively and neuroimaging showed no abnormal structures in the affected orbit. Pseudotumor may bleed and form a retrobulbar hematoma which carries the risk of visual loss.
一名75岁男性突然出现眶后疼痛、视力丧失、眶周瘀斑和复视，之前无外伤、鼻窦手术或感染迹象。神经眼科检查还发现患侧眼球运动明显受限、视力缺陷和眼球突出。神经影像学显示一个不规则形状的球后肿块，位于眼眶外下侧，部分突入下直肌和外直肌之间，增强造影剂后无强化。高剂量类固醇治疗对视觉症状改善甚微。针吸活检仅发现液性血肿。经眼眶外侧壁进行手术探查时，在下直肌和外直肌之间的分离过程中，巧克力色液化血肿溢出。未发现明显的血管病变。在血肿包膜内，发现一个附着于下直肌的小的紫色弹性软肿块，轮廓不规则。该肿块进行了次全切除。组织学诊断为伴有出血改变的炎性假瘤。未发现血管畸形成分。术后视觉功能和眼球运动得到改善，神经影像学显示患侧眼眶无异常结构。炎性假瘤可能出血并形成球后血肿，存在视力丧失的风险。
