Breast cancer with right eye proptosis and CN III deficits. There is diffuse ill-defined preseptal and postseptal soft tissue thickening and enhancement and stranding of the orbital fat, with mild right proptosis. There is enlargement of the right superior rectus muscle and hyperenhancement of the right superior oblique and medial and inferior rectus muscles. There is a defect in the right lamina papyracea with herniation of orbital fat and a portion of the medial rectus muscle. The right optic nerve appears to be intact. The left orbit is unremarkable. The bone marrow of the clivus appears to be diffusely heterogeneous. There are bilateral mastoid effusions. The imaged intracranial structures are unremarkable.
1. An infiltrative process involving the right preseptal and postseptal orbit may represent a breast cancer metastasis, although an infectious or post-traumatic process are differential considerations based on imaging.2. Right lamina papyracea fracture with herniation of orbital fat and medial rectus muscle herniation.3. Heterogeneity of the clivus may represent metastatic disease. A bone scan may be useful for further evaluation.4. Nonspecific bilateral mastoid effusions. 