Diagnosis: Unspecified exophthalmosClinical question: left orbital tumorSigns and Symptoms: left orbital proptosis and double vision There is unilateral enlargement and contrast enhancement of the left superior rectus muscle, the left medial rectus muscle and to a lesser degree the left lateral rectus muscle associated with some infiltration of the adjacent fat planes and a shaggy border along the involved muscles. The involved muscles are high signal on T2 and intermediate signal on T1. The sclera does not appear thickened. The extraocular muscle thickening appears to involve both the belly and the tendons. There is minimal infiltration along the left lacrimal gland The distance between the interzygomatic line and the cornea on the left side is 24 mm whereas on the right-side is17 mm.The left optic nerve sheath appear thickened and enhances.There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . The cavernous sinuses are symmetric and not enlarged.The left eyelid and preseptal space appear thickened.There is mild mucosal thickening in the ethmoid air cells.
1.Asymmetrically enlarged extraocular muscles associated with infiltration of the left orbit is suggestive of idiopathic orbital inflammatory disorder (pseudotumor) of the orbit. Please correlate with clinical symptoms of orbital pain. A lymphoproliferative lesion and less likely an atypical thyroid associated ophthalmopathy are differential considerations in the appropriate clinical setting. 2.Findings are suggestive of proptosis. Please correlate with clinical findings