Melanoma metastasis to medial rectus
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The medial rectus muscle is markedly enlarged by a heterogeneously enhancing mass. The central portion of the mass is necrotic and surrounded buy hemorrhage, but the peripheral portions enhance and extend in a finger-like fashion into the surrounding orbital fat.
This patient had known metastatic melanoma and this deposit is consistent with a metastases. In contrast to uveal metastases which are often bilateral (up to 25%), extraocular orbital metastases are usually unilateral (with the exception of neuroblastoma). Only infrequently primarily involve the extraocular muscles as is the case here.. the tumor that most often does this is melanoma.