Presentation
Painless diplopia and epistaxis. No past medical history.
Patient Data
Well-defined mass located in the medial extraconal space of the right orbit, pushing the medial rectus laterally .
Its extension through the ipsilateral ethmoid cells, the sphenoid and the maxillary sinus indicated rather an aggressive mass.
This abnormality was:
hypointense on T1 sequence
hyperintense on T2 (compared to the muscle)
isointense on diffusion (compared to the cortex) without any significative restriction
Moreover, there was a vivid and homogenous enhancement.
As there seemed to be a pachymeningeal thickening in the orbitofrontal lobe, a CT of the sinus with bone window was needed.
A CT of the sinus was subsequently performed.
Bony destruction of the roof, the medial wall and the floor of the right orbit was reported.
This finding indicated the aggressiveness of the lesion which was in favor of a malignant ethmoid or orbital tumor.
Case Discussion
A 40-year-old man, with no past medical history, was addressed in our emergency department because of a chronic and painless diplopia. He mentioned few episodes of spontaneous epistaxis from the right nostril.
A MRI was performed to rule out a tumor which might involve his right orbit. The finding of a well-defined, locally aggressive mass raised the hypothesis of a malignant tumor.
The need for a biopsy was raised at a multidisciplinary meeting with radiologists, ophthalmologists, and ENT specialists.
The pathological findings were consistent with inflammatory myofibroblastic tumor and surgery was consequently scheduled.
Unable to process the form. Check for errors and try again.