Published: 2022-02-24

Combined endoscopic and computed tomography guided trans-nasal embolisation of intramuscular hemangioma of the medial rectus muscle: a rare case

Sibasankar Dalai, Surendra Lele, Maya Gantayet, Aravind V. Datla


Hemangiomas are benign vascular malformations. Intramuscular hemangiomas (IMH) of the extraocular muscles are exceedingly rare. So far, only eight cases have been previously reported in the medical literature till date. We report a rare case of an intramuscular hemangioma of the medial rectus muscle presenting severe pain in the right eye and redness in the right sclera. We administered analgesics and steroids for six weeks, with no pain relief. Right ethmoidal dissection was done, and a window was made over the lamina papyracea, and a needle was placed directly into the mass under combined endoscopy and computed tomography (CT)-scan guidance. The mass was embolised with 33% glue and lipiodol. The patient recovered from the pain, and complete vision was restored. Eye discolouration got wholly cured within two weeks.


IMH, Medial rectus, Lamina papyracea, Endoscopic guidance, CT guided, Trans-nasal embolization, N-butyl cyanoacrylate, Lipiodol

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Moriarity JL, Wetzel M, Clatterbuck RE. The natural history of cavernous malformations: a prospective study of 68 patients. Neurosurgery. 1999;44(6):1166-73.

Calandriello L, Grimaldi G, Petrone G. Cavernous venous malformation (cavernous hemangioma) of the orbit: Current concepts and a review of the literature. Surv Ophthalmol. 2017;62(4):393-403.

Gade PS, Naik H, Bhople L, Velho V. Intramuscular hemangioma of the medial rectus as a rare cause of extraocular muscle enlargement: Report and review of literature. Neurol India 2019;67:601-4.

McNab AA, Selva D, Hardy TG, O’Donnell B. The Anatomical Location and Laterality of Orbital Cavernous Haemangiomas. Orbit. 2014;33: 359-62.

Jayaram A, Lissner GS, Cohen LM, Karagianis AG. Potential correlation between menopausal status and the clinical course of orbital cavernous hemangiomas. Ophthalmic Plast Reconstr Surg. 2015;31(3):187-90.

Tian YM, Xiao LH, Gao XW. Adhesion of cavernous hemangioma in the orbit revealed by CT and MRI: analysis of 97 cases. Int J Ophthalmol. 2015;4(2):195-8.

Allen PW, Enzinger FM. Hemangioma of skeletal muscle. An analysis of 89 cases. Cancer. 1972;29(1):8-22.

Lenzi R, Bleier BS, Felisati G, Muscatello L. Purely endoscopic trans-nasal management of orbital intraconal cavernous haemangiomas: a systematic review of the literature. Eur Arch Otorhinolaryngol. 2016;273(9):2319-22.

Christensen SR, Børgesen SE, Heegaard S, Prause JU. Orbital intramuscular haemangioma. Acta Ophthalmol Scand. 2002;80:336-9.

Kiratli H, Bilgiç S, Caǧlar M, Söylemezoǧlu F. Intramuscular hemangiomas of extraocular muscles. Ophthalmology 2003;110:564-8.

Kim SH, Shin HH, Rho BK, Lee ES, Baek SH. A case of intramuscular hemangioma presenting with large-angle hypertropia. Korean J Ophthalmol. 2006;20:195-8.

Lee BJ, Schoenfield L, Perry JD. Orbital intramuscular hemangioma enlarging during pregnancy. Ophthalmic Plast Reconstr Surg. 2009;25:491-3.

Charles NC, Belliappa S, Patel P. Intramuscular hemangioma of the inferior oblique: A rare cause of extraocular muscle enlargement. JAMA Ophthalmol. 2014;132:122-4.

Mehta A, Butola S, Naik M, Abrol S, Kumari A. Intramuscular cavernous hemangioma of medial rectus muscle in paediatric age group. Case Rep Ophthalmol Med. 2017;2017:1076404.

Li YJ, Barthès-Biesel D, Salsac AV. Polymerization kinetics of n-butyl cyanoacrylate glues used for vascular embolization. J mechanical behavior biomed materials. 2017;69:307-17.