We report a case of intramuscular hemangioma (IMH) in upper eyelid-misdiagnosed as pseudotumor-along with its pathologic findings.

A 48-year-old male patient presented with three months of upper eyelid swelling in his left eye of no symptom relief with oral corticosteroid for 5 weeks. Computed tomography findings show diffuse enhancement in left upper eyelid suggested for pseudotumor and retreated with oral corticosteroids and intralesional corticosteroid injections. However, lid inflammation was not improved. The patient underwent incisional biopsy.

Microscopically, the lesion was composed of proliferating vessels of various sizes between the individual muscle fibers. Intramuscular hemangioma that is rarely presented benign tumor in the head and neck region can be presented by diffuse swelling mimicking the pseudotumor rather than a palpable mass.