Orbital dermoid cyst - sack of marbles sign

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Painless right orbital swelling since childhood.

Patient Data

Age: 30 years
Gender: Female
This study is a stack
video
Download
Info

There is a well-defined right orbital cystic mass of supraocular location with heterogeneous hypoechoic echotexture containing numerous small echogenic areas giving the typical sack of marbles signThe video shows the mobile content of the cyst.

 

 

 

This study is a stack
Sagittal
T1
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
T2
This study is a stack
Axial
Gradient Echo
This study is a stack
Axial T2
fat sat
This study is a stack
T1 fat
sat
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
T1
C+
Download
Info

There is a well-defined right orbital mass of extraconal supraocular location, measuring 28 x 25 x 18 mm. Il elicits a homogeneous high signal on T1/T2 and FLAIR, attenuated on fat sat sequences with no enhancement following IV contrast. A mass effect is noted on the globe and superior rectus muscle which are displaced inferiorly and lacrymal gland which is displaced laterally. 

Case Discussion

Ultrasound and MRI features are highly suggestive of an orbital dermoid cyst with a "sack of marbles sign"

The "sack of marbles sign", also known as the marbles in a bag sign, corresponds to aggregations of multiple small globules of fat within a cyst mimicking marble spheres within a sack. They appear hyperechoic on ultrasound within the hypoechoic content of the cyst, fat attenuation on CT, and high signal on T1WI and T2WI on MRI. It is considered highly suggestive of a dermoid cyst.

 

Additional contributor: C. Boukaaba, MD

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.