A 7-year-old girl has a smooth, non-tender bluish inferior medial orbital swelling that increases with crying and the Valsalva manoeuvre. MRI shows a heterogeneous lesion with fluid-fluid levels. The MOST likely diagnosis is:

• A Capillary haemangioma
• B Dermoid cyst
• C Rhabdomyosarcoma
• D Venous malformation (orbital varix) ✓

Explanation

An orbital venous malformation (varix) characteristically enlarges with increased venous pressure (Valsalva, crying, head-down position) and reduces on head elevation. MRI shows phleboliths, fluid-fluid levels from haemorrhage at different stages, and enhancement on contrast. Capillary haemangiomas involute spontaneously and do not vary with Valsalva. Dermoid cysts are non-compressible and located at suture lines. Rhabdomyosarcoma is rapidly progressive and non-compressible.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.