3,20 For discussion of these lesions, and others, we direct the reader to the referenced sources.Ĭontrast enhanced MRI is the preferred modality for imaging hemangioma, although CT can also be considered if it is not possible to sedate the patient for MRI. 3,7 One may also encounter other masses that are not true neoplasms, such as dermolipomas, 3,16,17 dermoid cysts, 3,18–20 and epidermoid cysts. In addition, a number of other vascular lesions and neoplasms are not discussed, including orbital venous varix, 3,7,8 arteriovenous malformation, 3,9 cavernous sinus thrombosis, 3,10 carotid cavernous fistula, 3,7,8 a variety of benign and malignant mesenchymal tumors, 3,11,12 epithelial neoplasms of the lacrimal apparatus, 3,7,13–15 and ocular tumors that secondarily involve the orbit.

Due to space constraints, infection 1–3 and inflammatory disease 3–6 are not discussed here.

This review focuses on the most common vascular masses, benign neoplasms, and malignant neoplasms. Our goal is to review the most commonly encountered lesions to make the reader aware of their typical appearances and presentations, with emphasis on key imaging features that may distinguish among similar lesions. Although MRI can be more difficult to perform, it can reveal additional key imaging features that allow one to more confidently distinguish between similar appearing lesions, and often arrive at a single most likely diagnosis. CT is excellent for confirming the presence of a mass, is well tolerated, can be rapidly obtained at most medical centers, and gives clues to the specific diagnosis. The first step in establishing a differential diagnosis is obtaining an accurate clinical history. Imaging can be used to precisely localize a lesion, to help establish a diagnosis or generate a differential diagnosis that guides management, to follow a known lesion for progression, or some combination of these. These include benign neoplasms, malignant neoplasms, vascular lesions, inflammatory disease, congenital lesions, and infection, among other causes.

A wide variety of processes can produce space-occupying lesions in and around the orbit.

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