Intra-conal orbital metastasis - breast cancer
Progressive left visual loss over the last few weeks. Past history of metastatic breast cancer with liver involvement.
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Enhancing intra-conal mass (with restricted diffusion) in the posterior orbit encircling and compressing the optic nerve. Note subtle T2 brightening in the optic nerve anterior to the mass indicative of edema.
Purely intraconal mass lesions are rare and have a large differential diagnosis. In this case the mass has an aggressive appearance and is painless thus the differential is limited to metastasis (in this case breast) and lymphoma. Metastatic tumors to the orbit are very rare with breast being the most common followed by melanoma. Involvement is often intra and extraconal, infiltrating the ocular muscles.