Ординатура / Офтальмология / Английские материалы / Imaging of Orbital and Visual Pathway Pathology_Muller-Forell_2005

Fig. 6.77. A 49-year-old woman with persistent Graves’ disease. Axial CT shows severe thickening of the medial rectus muscles, more pronounced on the right side, and marked bilateral pressure on the lamina papyracea. Note substantial hypertrophy of the orbital fat, responsible for extreme exophthalmos and stretching of both optic nerves. (With permission of

Müller-Forell and Lieb 1995b)

Fig. 6.79a–f. A 50-year-old woman with bilateral proptosis in the course of Graves’ disease. Diagnosis: Graves’ disease. CT: a Preoperative view with bilateral symmetric enlargement of the medial and (less marked) lateral rectus muscles. Note slight impression of the medial orbital wall as some spontaneous decompression. b Corresponding postoperative view with protrusion of the medial rectus muscles in the former ethmoidal cell area. MRI: c axial T1-weighted view, corresponding to a. d Corresponding postoperative image. Note that the enlargement of the muscles themselves remains unaffected. e Coronal T1weighted preoperative view. f Corresponding postoperative image

Fig. 6.80a–d. A 51-year-old woman with known Graves disease. One day after operative fat resection of the left eye, the patient developed acute deterioration of the severe proptosis (right: 29 mm, left 33 mm), but no visual deficit. Diagnosis: acute retrobulbar hemorrhage (as an operative complication). CT: a Axial, native view of the medial orbit, where demonstrating bilateral severe proptosis and inferior dislocation of the left globe. b Axial view of the upper orbit with hyperdense mass in the region of the left superior muscle complex. c Coronal view of the region of the posterior globe where the hyperdense hemorrhage is seen, apparently involving the superior rectus muscle. d Coronal view of the anterior orbit, demonstrating best an inferior dislocation of the protruded left globe by the space-occupying hemorrhage

Fig. 6.82a–f. A 71-year-old man with persistent, slowly progressing, right-sided proptosis, but an acute history of ipsilateral painful chemosis. Diagnosis: orbital amyloidoma. CT: a Axial native view where medial of the orbit, in addition to exophthalmos of the right eye and extraconal location of the slightly enlarged lacrimal gland, an irregular contour of the lateral rectus muscle and adjacent bulbar fat can be identified. b Axial native view of the superior orbit which is characterized by an irregular, partly calcified mass. c Coronal view of the middle orbit, demonstrating the partly calcified intraconal mass between the lateral and superior rectus muscle. MRI: d Axial T1-weighted native view, corresponding to b. Note the small, normal superior ophthalmic vein in both images. e Corresponding contrast-enhanced (FS) view without marked contrast enhancement of the mass. f Coronal T1-weighted view (corresponding to c) with suspicion of additional extraconal involvement

d

c

Fig. 6.83a–f. A 57-year-old woman with known NF 1, and enophthalmos for the past 6 weeks, combined with increasing double vision for all directions of the left eye. Diagnosis: (estrogen-receptor positive) metastasis of a cirrhotic breast carcinoma as initial symptom of the disease. MRI: a Axial proton density view of the orbit, demonstrating enophthalmos of the left eye, pathologic signal intensity of the retrobulbar space and widening of the CSF space of the left optic nerve. b Corresponding T1-weighted native view, distinguishing only little intraand extraconal (medially) fat (arrows). c Corresponding T1-weighted, contrast-enhanced (FS) view, showing enhancement of the entire orbital tissue (compare with corresponding right side). d Coronal T1-weighted native view with similar signals of the rectus muscles and of the primarily intrabut also extraconal tumor. Remnants of orbital fat are seen as small hyperintense structures in the inferior left orbit. e Corresponding T1-weighted, contrast-enhanced (FS) view with complete tumor enhancement. f Parasagittal T1-weighted IR view, demonstrating compression of the optic nerve and widening of the CSF space in the optic nerve sheath (compare to a)

Fig. 6.85a–e. A 36-year-old man undergoing imaging prior to planned surgical correction of persistent divergent strabismus. Diagnosis: NF 1 with sphenoid wing dysplasia and subsequent muscle degeneration. CT: a Axial image with deformed left orbital content: deformed globe and lateral rectus muscle as well as bony pathology are more conclusively visualized in corresponding view in bone window (b). Impression of the lamina papyracea, thickening of the large wing of the sphenoid, and widening of the orbital fissure (normal optic canal – not shown), apparently due to the absence of the small wing of the sphenoid, findings leading to suspected NF 1. MRI: c Corresponding axial native T1weighted view. Note the deformed left globe. d Corresponding contrast-enhanced (FS) image demonstrating the spread of single muscle fibers of the lateral rectus muscle, expanding intracranially and impinging on the temporal pole. e Coronal T1-weighted view at the level of the optic canal (white star: right, white arrow: left), showing extensive intracranial

expansion of intraorbital tissue

e