FP12

The waxing and waning lacrimal fossa swelling 

Purpose:  To highlight the atypical presentation of an orbital venous malformation in a young male with lacrimal sac swelling. 
Case summary: A young male with an uninflamed mass in the left medial canthal area diagnosed as lacrimal sac mucocele and advised for dacryocystorhinostomy came for second opinion. It was not associated with epiphora, discharge, pain although he had history of blunt trauma over nasal bridge 7 years back.  The soft compressible painless swelling started soon after +trauma, gradually progressed, increases in size on Valsalva manoeuvre, no regurgitation on pressure and syringing freely patent. Dynamic contrast MRI confirmed low flow vascular lesion at inferomedial canthus of left orbit with post contrast enhancement and no intraorbital extension. The patient underwent glue assisted excision biopsy; histopathology revealed variably dilated closed packed thin-walled vessels with occasional phleboliths.