著明な眼瞼，眼窩血腫をきたした小児眼窩血管腫の1症例

Severe intrapalpebral hemorrhage and orbital hematoma in a child of orbital cavernous hemangioma

要約　5歳女児が3日前からの皮下出血を伴う強い右上眼瞼腫脹で受診した。複数の画像診断で，上眼瞼から眼窩にかけて血性の囊腫様病変があった。3週後に視力が低下し，眼圧が28mmHgに上昇した。眼瞼部の穿刺吸引で陳旧化した血液が得られ，眼窩血腫が疑われた。眼圧は正常化したが，眼瞼腫脹は持続した。まず経皮的，続いて経頭蓋的に腫瘤を摘出し，病理組織学的に海綿状血管腫と診断された。術後，眼瞼腫脹はほとんど消失し，視力も正常化した。本症例では，筋円錐外の海綿状血管腫が自然出血して血腫を形成したと推定された。

Abstract.　A 5-year-old girl presented with severe swelling of right eyelid and subcutaneous hemorrhage since 3 days before. Diagnostic imagings showed a bloody cystic mass extending from the orbit to the upper eyelid. She developed impaired visual acuity with elevated intraocular pressure 3 weeks later. Bloody fluid was obtained by aspiration through the eyelid,suggesting orbital hematoma. The intraocular pressure normalized after this procedure but palpebral swelling persisted. The tumor was removed first by percutaneous approach and finally by transcranial approach. It was diagnosed,histopathologically,as cavernous hemangioma. The eyelid swelling almost disappeared after surgery followed by recovery of visual acuity. It appeared that the hematoma was due to hemorrhage from the cavernous hemangioma located outside the muscle cone in the orbit.