Clinical question: Patient with hx of left lid ptosis, developed solitary fibrous tumor of the superior maxillary sinus with invasion into the orbit. S/p subtotal resection.Signs and Symptoms: left eye ptosis and and diplopia. MRI orbits:There is a mass which is centered along the inferior aspect of the left orbit which extends to involve the superior aspect of the maxillary sinus and inferior aspect of the left orbit. It previously measured 43 x 40 the millimeters coronal dimensions and now measures 35 x 32 mm coronal dimensions. It previously involved the majority of the left maxillary sinus. It is now smaller. The patient is status post left-sided paranasal sinus surgery. Some mucosal thickening is present in the left maxillary sinus. The mass is visually contiguous with the optic nerve sheath complex and abuts the left eye. There is anterior displacement of the left eye. The distance between the atraumatic line and the lens of the left eye is approximately 22 mm. The optic nerve is displaced superiorly; the inferior rectus muscle and inferior oblique muscle are displaced superiorly. The mass abuts the left medial rectus muscleA small left parotid well-circumscribed lesion measuring 5 mm in diameter is bright on T2-weighted imaging it is unchanged compared to the prior exam.There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .
1.There is a large mass centered along the floor of the left orbit which involves left maxillary sinus and of the left orbit with intraconal extension which is smaller in size on the current exam when compared to the previous exam. It displaces the left eye, left optic nerve and left inferior rectus and inferior oblique muscles.2.Findings raise the question of proptosis related to the patient's above described mass.