Orbital pseudotumor

Case contributed by Dr Suresh Babu Boddapati

Presentation

Right eye proptosis, pain and diplopia. Recurrent episodes for 2 years.

Patient Data

Age: 20 years
Gender: Female

NCCT head with orbit cuts

CT

Diffusely enlarged right lateral rectus muscle and right lacrimal gland. 

Brain parenchyma and paranasal sinuses are normal.

MRI

The right lateral rectus muscle is diffusely enlarged and shows intense homogenous contrast enhancement. There is extension of inflammation to the right lacrimal gland which is also enlarged and shows homogenous contrast enhancement. inflammation of the adjacent soft tissue also seen.  

MRI of the brain is normal. No abnormal meningeal enhancement or thickening seen.

Paranasal sinuses are normal.

Case Discussion

The right lateral rectus muscle is diffusely enlarged and shows intense homogenous contrast enhancement. There is extension of inflammation to the right lacrimal gland and adjacent soft tissue with contrast enhancement.  

Thyroid hormonal profile is normal. Serum for IgG4 antibodies was negative. Non-specific inflammation was noted in the biopsy. IHC staining for IgG4 antibodies was negative. 

A diagnosis of idiopathic orbital inflammation was made. The patient is being treated with corticosteroids and immunosuppressants although with multiple episodes of remissions and relapses. 

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