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Joseph Junewick, MD FACR
over 8 years ago
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Orbital Pseudotumor

Case Detail

Anatomy:
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CR MR
Activities:
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History

Teenager with painful and acute proptosis.


Case Images


Diagnosis

Orbital Pseudotumor

Findings

MR – Fusiform enlargement and enhancement of the ocular muscles bilaterally.

Discussion

Orbital pseudotumor is the most common primary tumor of the orbits. Orbital pseudotumor is most often unilateral; bilaterality suggests systemic disease. Scleral and uveal thickening and enhancement is present in one-third of patients and are thought to be specific signs of orbital pseudotumor.

Orbital pseudotumor occurs at all ages but is most common in midlife. Patients present with exophthalmos and acute eye pain; neoplasia presents with indolent painless proptosis. Other signs and symptoms include decreased ocular motion, diplopia, ptosis, chemosis and decreased acuity.

Differential diagnosis includes infection (fungal, HIV, syphilis, tuberculosis), inflammation (contiguous sinusitis, Tolosa-Hunt syndrome), neoplasia (lymphoma, brain tumors, metastatic disease), thyroid ophthalomyopathy, carotid-cavernous fistula, sarcoidosis, amyloidosis, and vasculitis (polyarteritis nodosum, Wegener’s granulomatosis).

Reference

Narla LD, et al. Inflammatory Pseudotumor. Radiographics (2003); 23:719-729.



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