Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example. 