Orbital lymphangioma mimicking cellulitis: Diagnostic contribution of MRI and successful management with bleomycin sclerotherapy

Orbital lymphangioma is a rare benign low-flow venous–lymphatic malformation that typically presents with slowly progressive proptosis in children. Acute inflammatory presentations mimicking orbital cellulitis are uncommon and may lead to diagnostic delay. We report the case of an 11-year-old girl presenting with acute left-sided facial swelling and proptosis following an upper respiratory tract infection. Initial management for presumed orbital cellulitis with intravenous antibiotic therapy was unsuccessful. Contrast-enhanced CT showed diffuse soft tissue infiltration without abscess formation, while MRI revealed a multiloculated cystic lesion with hemorrhagic components involving both intra- and extraconal spaces, consistent with orbital lymphangioma. The patient underwent 3 sessions of bleomycin-based sclerotherapy at 1-month intervals, with good tolerance and no complications. Progressive clinical improvement was observed, with complete resolution of proptosis and chemosis at 5 months and no recurrence at 1-year follow-up. This case highlights the key role of MRI in differentiating orbital lymphangioma from infectious processes and supports sclerotherapy as an effective minimally invasive treatment option.