A 40-year-old man presents with intermittent left-sided proptosis that worsens on bending forward or performing the Valsalva maneuver. There is no pain or visual loss. CT orbit with Valsalva shows an enhancing vascular mass. The most likely diagnosis is:
- A Orbital cavernous hemangioma
- B Orbital varix ✓
- C Orbital lymphangioma
- D Carotid-cavernous fistula
Correct answer: B. Orbital varix
Explanation
Orbital varix is a low-flow venous malformation that characteristically produces intermittent proptosis exacerbated by Valsalva maneuver or bending forward, due to gravitational venous engorgement. CT with Valsalva confirms the enhancing vascular lesion. Cavernous hemangioma does not change with position. Lymphangioma may hemorrhage and cause sudden proptosis but is not characteristically Valsalva-dependent. Carotid-cavernous fistula presents with pulsatile proptosis and bruit.
Reference: Rootman's Diseases of the Orbit, 3rd ed.
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Written and medically reviewed by the StethoPrep medical team.