Presentation
Presents with proptosis in the setting of known metastatic colorectal cancer.
Patient Data
Multiple enhancing intra-axial lesions of varying size at the following locations:
- post central gyrus, with surrounding edema
- posterior left frontal lobe x 2
- left occipital lobe
- right parietal lobe, with surrounding edema
Surrounding the right zygoma and extending superiorly over the right parietal bone (with underlying bone periosteal reaction) is an enhancing soft tissue mass. It extends into the lateral and superior walls of the extraconal space of the right orbit, abutting the lateral rectus muscle and globe.
Overlying the right anterior temporal pole and lateral right frontal lobe is an enhancing extra-axial soft tissue mass.
Case Discussion
The findings are consistent with metastases with intra-axial, extra-axial and orbital involvement.
The soft tissue mass surrounding the right zygoma extending into the right orbit and implicating the lateral rectus muscle is the cause of the patient's proptosis.
The extra-axial soft tissue mass is highly suspicious of dural metastases.
Learning points:
- colorectal carcinoma is one of the more common primary malignancies resulting in brain metastases.
- proptosis is a potential sign of orbital metastases.
- other differentials to consider in the setting of an extraconal orbital lesion include: infectious causes (including orbital cellulitis), mucocoele, sinonasal neoplasms and lymphoma.
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