Korean J Ophthalmol.  2006 Sep;20(3):195-198. 10.3341/kjo.2006.20.3.195.

A Case of Intramuscular Hemangioma Presenting with Large-angle Hypertropia

• Kim SH
• Shin HH
• Rho BK
• Lee ES
• Baek SH

• KMID: 754580
• DOI: http://doi.org/10.3341/kjo.2006.20.3.195

Abstract

PURPOSE: To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). METHODS: A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. RESULTS: Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. CONCLUSIONS: This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.

Keyword

Extraocular muscle enlargement; Intramuscular hemangioma; Large-angle hypertropia

MeSH Terms

Strabismus/diagnosis/*etiology
*Oculomotor Muscles
Muscle Neoplasms/*complications/diagnosis
Middle Aged
Male
Magnetic Resonance Imaging
Humans
Hemangioma/*complications/diagnosis
Eye Neoplasms/*complications/diagnosis
Disease Progression
Diagnosis, Differential
Biopsy

Figure

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  Fig. 1 Eye movements of a 63-year old patient. (a) Nine cardinal movements of eyeballs on preoperative day. Right hypertropia and significant limitation of downward gaze of the right eye was noted. (b) The fixating eye could be changed when the left eye was occluded.

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  Fig. 2 Orbital MRI T1-weighted gadolinium enhanced images. (a) Axial view demonstrates the fusiform enlargement of the right superior rectus with marked enhancement. (b) Coronal view demonstrates the marked enlargement of the right superior rectus with an irregular pattern of enhancement.

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  Fig. 3 Histopathologic analysis of biopsy. (a) Large, variable-sized vessels (white arrows) infiltrating between muscular fibers (Hematoxylin-eosin stain; original magnification, ×200). (b) Immunohistochemical stain revealed smooth muscle cells in the walls of both small and large blood vessels (white arrows) (smooth muscle actin, original magnification, ×200).

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