Acute Exacerbation of the Orbital Angioleiomyoma With Hemodynamic Changes

A 58-year-old woman presented with progressive proptosis and intermittent eye pain. Imaging showed an orbital mass with a central thrombus, initially suspected as a thrombosed venous malformation. However, rapid symptom worsening with visual loss necessitated further evaluation. Transfemoral cerebral angiography demonstrated a vascular mass supplied by the ophthalmic artery with venous drainage to the cavernous sinus, suggesting an arteriovenous malformation. The patient underwent transvenous embolization followed by surgical excision. Histopathological examination confirmed angioleiomyoma with thrombus formation. This case highlights a rare presentation of orbital angioleiomyoma with acute exacerbation due to hemodynamic changes. The combined approach of embolization and surgical resection proved effective in managing the orbital tumor, reducing complications, and achieving complete resolution of symptoms.