小児眼球突出における診断のジレンマ - 悪性腫瘍の疑いから良性の眼窩海綿状静脈奇形まで：症例報告

Rapidly progressive proptosis in children can be caused by multiple causes. Distinguishing between these is challenging, especially when presentations mimic malignancy.

A healthy Malay 3-year-old boy presented with a 1-week history of painless, progressive left eye proptosis. Initial imaging showed intraconal and extraconal orbital masses with prominent vascular channels, suggesting a vascular lesion. Two weeks later, he developed fever, lethargy, and worsening proptosis. Repeat imaging revealed lesion enlargement with intralesional hemorrhage, displacement of orbital structures, and a dilated superior ophthalmic vein. Differential diagnoses included rhabdomyosarcoma, orbital cellulitis, and venolymphatic malformation. Anterior orbitotomy and debulking were performed, and histopathology confirmed cavernous venous malformations with thrombosed vessels. At 6 months, there was no recurrence, but dense corneal scarring left the visual prognosis uncertain.

Cavernous venous malformation is rare in children and usually progresses slowly. Acute enlargement from intralesional hemorrhage can mimic malignant or infectious disease. In pediatric orbital masses, careful clinical assessment, targeted imaging, and histopathological confirmation remain essential. Early multidisciplinary intervention is key to preserving vision when rapid progression threatens the eye.