Clinical question: Assess for bony dehiscence in the left lamina papyracea and left medial orbital wall seen on recent sinus CT. Pre- and post enhanced MRI of orbits:Examination demonstrates diffuse signal abnormality of all paranasal sinuses similar to prior study. The signal intensity of the sinuses mostly suggestive of fungal sinusitis evident by low T2 signal intensity. Diffuse intermixed foci of T2 hyperintensity representing mucosal thickening and fluid examination.As was noted on prior CT there is significant expansion of the left ethmoid sinuses with deviation of the lamina papyracea toward the left retroperitoneal space. There is diffuse linear mucosal enhancement of the sinuses and with multiple foci of hypoenhancement corresponding to region of low T2 signal intensity and consistent with fungal infection. There is also bulging of contents of superior ethmoid air cells into the intracranial space bilaterally (left greater than right) without significant change since prior exam. There is however no detectable inflammatory changes are retro-orbital space or any abnormal retro-orbital enhancement. Also no detectable foci of parenchymal edema or abnormal ecchymosis/meningeal enhancement in bilateral frontal region. This observation suggest that the expansion of the sinuses into the left orbit and bilateral infra frontal regions are likely still secondary to remodeling expansion/significant bony thinning of the sinuses and less likely with bony breakthrough as was suspected on CT exam.Images through the retro-orbital spaces demonstrate normal signal intensity and pattern of enhancement of extraocular musculature. Normal signal intensity of retro-orbital fat, optic nerves and without abnormal enhancement. Normal signal intensity and morphology of bilateral globes without abnormal enhancement.
1.Diffuse opacification of all paranasal sinuses with mixed signal patterns of low T2 and high T2 signal intensity suggestive of fungal sinusitis and with overlapping postobstructive fluid and mucosal thickening.2.There is bulge of the contents of ethmoid sinuses into the left orbit and to a lesser degree in bilateral inferior aspect of anterior cranial fossa (left greater than right) similar to preoperative exam.3.There is no evidence of any inflammatory changes or abnormal enhancement/cavity formation in the retro-orbital spaces or the intracranial spaces.4.Mild mass effect on the left medial rectus muscle and unremarkable images through the orbits otherwise. Please see above comments.