Intravenous pyogenic granuloma of the angular vein

A 47-year-old woman presented with a painful mass below her left medial canthus. Examination revealed a 1-cm tender, smooth, pulseless, mobile mass inferior to the level of the anterior lacrimal crest. CT imaging was performed. Excision of the involved angular vein revealed a smooth, intralumenal lesion. Histopathologic examination demonstrated intravenous pyogenic granuloma (IVPG). There are approximately 30 reported cases of IVPG in the English literature, 2 of which arise in the periocular angular vein. The ultrasound and MRI characteristics of IVPG have been previously described. We describe the CT profile of this rare, benign tumor as a mildly heterogeneic, contrast-enhancing cylindrical lesion within, and conforming to the shape of, the angular vein. There is dilatation of the vein proximal to the lesion with marked narrowing distal to it secondary to obstruction of flow. On noncontrast imaging, the lesion is isodense with nasal mucosa and without calcifications.