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Subcutaneous Forehead and Incidental Orbital Varices Diagnosed with MRI Under Sedation
Levi Sanchez Ramirez1, Bita Esmaeli2, Hila Goldberg2
1Baylor College of Medicine, Houston USA.
Insights
Positional changes during Magnetic Resonance Imaging (MRI) aided in diagnosing venous varices in a child. This method confirmed forehead and orbital varices without radiation exposure, offering a safer diagnostic alternative.
Area of Science:
- Radiology
- Pediatric Imaging
- Vascular Malformations
Background:
- Intermittent head and neck lesions can present diagnostic challenges.
- Positional changes can influence the size of vascular malformations.
- Accurate diagnosis in children often requires minimizing radiation exposure.
Purpose of the Study:
- To describe the utility of positional Magnetic Resonance Imaging (MRI) in diagnosing head and neck venous varices in a pediatric patient.
- To highlight an alternative to Computed Tomography (CT) for diagnosing varices, avoiding radiation exposure.
- To review the clinical and imaging features of head and neck varices.
Main Methods:
- A 5-year-old boy with an intermittent forehead lesion underwent MRI with and without contrast.
- Positional imaging (right lateral decubitus) was performed to assess lesion behavior.
- MRI findings were correlated with clinical presentation.
Main Results:
- The forehead lesion demonstrated a positional increase in size, consistent with a venous varix.
- An incidental extraconal orbital mass also showed positional enlargement, confirming an orbital varix.
- MRI with positional changes successfully diagnosed two varices without radiation exposure.
Conclusions:
- Positional MRI is an effective tool for diagnosing head and neck venous varices in children.
- This technique avoids ionizing radiation, making it a preferable alternative to CT in pediatric cases.
- Understanding the positional behavior of lesions is crucial for accurate diagnosis of vascular malformations.
Abstract:
A 5-year-old boy presented for evaluation of an intermittent lesion in the left forehead that, per history from his mother, enlarged when the child slept on his right side. On clinical exam, although there were no notable findings with the child in the upright position, fullness and an enlarging mass when the child was placed on his right side could be reproduced. A diagnosis of a venous varix was suspected. Under sedation, a routine Magnetic Resonance Imaging of the orbits without and with intravenous contrast in the supine position and an axial T1 post-contrast in the right lateral decubitus position was obtained. The forehead lesion demonstrated a positional increase in size and had the Magnetic Resonance Imaging appearance of a varix. An incidental extraconal mass was also noted on Magnetic Resonance Imaging, which had the appearance of a varix and also increased in size in the right lateral decubitus position, confirming the diagnosis of an orbital varix. This case reviews the clinical presentation and imaging findings of two head and neck varices that were diagnosed with Magnetic Resonance Imaging under sedation using positional changes, thus, negating the need for radiation exposure to a child if Computed Tomography was utilized for the radiologic diagnosis.
