Unusual Deep Infantile Hemangioma Presentation with Orbital Involvement

A 45-day-old boy presented with 2 weeks of worsening right-sided facial swelling concerning for dacryocystocele. The patient did not respond to a 7-day course of intravenous clindamycin. Physical examination revealed periorbital and maxillary swelling without erythema or induration (A). Magnetic resonance imaging revealed a 3×3×2–cm lobulated mass in the right inferior orbit with proptosis and partial encasement of the optic nerve (B). Given concerning features on imaging, biopsy was performed, showing tightly packed capillaries organized into lobules and endothelial cells staining for glucose transporter 1 (GLUT-1) (C). This confirmed the lesion as an infantile hemangioma; oral propranolol was initiated with significant improvement (D). (Magnified version of Figure A-D is available online at www.aaojournal.org).