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Age: 51

Sex: Female

Indication: Diplopia

Save ("V")

Case #22


Findings

  • Infiltrative enhancing soft tissue encasing the left optic nerve in the orbital apex and contacts the extraocular muscles with notable enlargement of the adjacent superior and lateral rectus muscles
  • Diffusely enhancing, dural-based mass along the clivus and right greater wing of the sphenoid with extension into the right aspect of the cavernous sinus abutting the right internal carotid artery posterior genu and terminus, the posterior aspect of the sella with displacement of the pituitary infundibulum, the right Meckel’s cave, the right middle cranial fossa with a peritumoral cyst exerting mass effect on the medial right temporal lobe, and the prepontine cistern with mass effect on the midbrain and pons, encasement of the basilar artery (as well as the P1 segment of the right PCA, right superior cerebellar artery, and right posterior communicating artery), and displacement of the cisternal segment of the right trigeminal nerve. A dural tail extends inferiorly along the clivus and into the right internal auditory canal
  • No evidence of acute infarct, hemorrhage, or hydrocephalus


Diagnosis

  • Orbital pseudotumor

Sample Report

Infiltrative process in the left orbit with extraocular muscle involvement, particularly the superior and lateral rectus muscles, suggestive of orbital pseudotumor which could relate to IgG4 disease or sarcoidosis.

Right petroclival meningioma with extensive involvement of adjacent structures including invasion of the cavernous sinus and right Meckel’s cave, displacement of the pituitary infundibulum, displacement of the cisternal segment of the right trigeminal nerve, and encasement of the basilar artery, P1 segment of the right PCA, right superior cerebellar artery, and right posterior communicating artery, which appear patent.

No evidence of acute infarct, hemorrhage, or hydrocephalus.


Discussion

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Images

Orbital pseudotumor with marked enlargement of the superior (red arrow) and lateral (yellow arrow) rectus muscles.



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