Imaging eye lesionImaging eye lesion

DR. Rekha KhareDR. Rekha Khare

M.D. RadiologyM.D. Radiology

Common clinical problem Common clinical problem to imageto image

PROPTOSISPROPTOSIS

ProptosisProptosis

It is abnormal protrusion of eye ballIt is abnormal protrusion of eye ball

_unilateral_unilateral

_bilateral_bilateral

Causes of proptosisCauses of proptosis

V_ vascular ( av malformation )V_ vascular ( av malformation ) E_ endocrinal ( thyrotoxicosis ) E_ endocrinal ( thyrotoxicosis ) I_ Infection/ inflammationI_ Infection/ inflammation N_ neoplasm ( primary/ secondary )N_ neoplasm ( primary/ secondary )

( local/ intracranial )( local/ intracranial )

Imaging modalityImaging modality

Plain X- ray_ no valuePlain X- ray_ no value Ultrasound_ little helpUltrasound_ little help CT scanCT scan MRI scanMRI scan

CT versus MRICT versus MRI

MRI_ superb tissue contrastMRI_ superb tissue contrast

choice of imaging if available and choice of imaging if available and

affordableaffordable

Contd.Contd.

CT scan_CT scan_

-tissue contrast just comparable -tissue contrast just comparable -easily affordable and available -easily affordable and available

-easy assessment of PNS/ nasal cavity -easy assessment of PNS/ nasal cavity and or bone involvementand or bone involvement

-intracranial extension -intracranial extension

“ “Common diagnostic tool in routine”Common diagnostic tool in routine”

What to see on CT scan?What to see on CT scan?

eye balleye ball eye muscles ( extra ocular )eye muscles ( extra ocular ) retro bulbar spaceretro bulbar space optic nerveoptic nerve bony socket bony socket adjoining paranasal sinus/ nasal cavityadjoining paranasal sinus/ nasal cavity intracranial tissue intracranial tissue

Eye image on CT scanEye image on CT scan

Eye mass_ proptosisEye mass_ proptosis

Ring enhancedRing enhanced

cystic lesion in Rt.cystic lesion in Rt.

retro bulbar retro bulbar regionregion

? abscess ? abscess (HIV+ve)(HIV+ve)

Eye mass_ proptosisEye mass_ proptosis

Ring enhancedRing enhanced

lesion in retrolesion in retro

bulbar regionbulbar region

+ ethmoidal + ethmoidal

sinusitissinusitis

? abscess ? abscess

Eye mass_ proptosisEye mass_ proptosis

Retrobulbar massRetrobulbar mass

nature?nature?

Eye mass_ Proptosis Eye mass_ Proptosis

HomogenousHomogenous

enhanced enhanced

few calcification few calcification obscuring obscuring

optic nerveoptic nerve

? Meningioma? Meningioma

Same caseSame case

RetrobulbarRetrobulbar

mass mass compressing compressing extraocular extraocular muscles muscles deforming eye deforming eye ballball

ProptosisProptosis

Thick extraocular Thick extraocular muscles andmuscles and

Optic nerveOptic nerve

(HIV+ve case)(HIV+ve case)

? Lymphoma? Lymphoma

D/D thyrotoxicosisD/D thyrotoxicosis

( fusiform muscles)( fusiform muscles)

ThyrotoxicosisThyrotoxicosis

fusiform fusiform extraocular muscleextraocular muscle

Same caseSame case

ThyrotoxicosisThyrotoxicosis

Eye mass_ proptosisEye mass_ proptosis

Soft tissue mass Soft tissue mass

obscuring optic obscuring optic nerve infiltrating nerve infiltrating lat. muscle ? lat. muscle ? Optic nerve Optic nerve sheath sheath meningioma meningioma

Eye mass_ proptosisEye mass_ proptosis

Enhanced mass Enhanced mass medial medial retrobulbar region retrobulbar region displacing optic displacing optic nerve?nerve?

pseudo- tumourpseudo- tumour

Eye mass_ proptosis Eye mass_ proptosis

Enhanced mass Enhanced mass from extraocularfrom extraocular musclemuscle?Lymphoma?Lymphoma?? rhabdomyosarcoma?? rhabdomyosarcoma

Eye mass_ proptosisEye mass_ proptosis

Heterogenous Heterogenous enhanced mass enhanced mass filling retrobulbar filling retrobulbar region, deforming region, deforming eye ball? eye ball? Malignant mass Malignant mass

Extra orbital lesionsExtra orbital lesions

Lesions can cause proptosis if fromLesions can cause proptosis if from

paranasal sinus/ nasal cavity or paranasal sinus/ nasal cavity or

intracranial mass extension orintracranial mass extension or

bones in surrounding bones in surrounding

Proptosis _ post. op caseProptosis _ post. op case

Intracranial mass/ Intracranial mass/

abscess with bone abscess with bone destructiondestruction

Check next sliceCheck next slice

Same caseSame case

Extracerebral Extracerebral mass/abscess mass/abscess drainage donedrainage done

aggressive infectionaggressive infection

gone deep gone deep

ProptosisProptosis

Calcific density Calcific density mass Rt. mass Rt. Retrobulbar Retrobulbar pushing eye ball pushing eye ball anteriorlyanteriorly

? Congenital bony ? Congenital bony DysplasiaDysplasia

ProptosisProptosis

Extra orbital Extra orbital midline malignant midline malignant mass from base mass from base of skull of skull

Paranasal sinusParanasal sinus

Nonenhanced Nonenhanced expansile cystic expansile cystic

mass lesion in Rt.mass lesion in Rt.

frontal sinusfrontal sinus

? mucocele ? mucocele

Paranasal sinusParanasal sinus

Nonenhanced Nonenhanced expansile cystic expansile cystic mass lesion in Rt.mass lesion in Rt.

frontal sinusfrontal sinus

? mucocele? mucocele

Paranasal sinusParanasal sinus

Frontal mucoceleFrontal mucocele

Paranasal sinusParanasal sinus

Huge soft tissue Huge soft tissue mass displacingmass displacing

and compressing and compressing eye ball ? eye ball ?

ethmoidal ethmoidal mucocelemucocele

Paranasal SinusParanasal Sinus

Ethmoidal mucoceleEthmoidal mucocele

Paranasal sinusParanasal sinus

Nonenhanced Nonenhanced expansile expansile

cystic lesion in cystic lesion in sphenoidal sinussphenoidal sinus

?mucocele?mucocele

might cause might cause proptosis if hugeproptosis if huge

Paranasal sinus_ massParanasal sinus_ mass

Paranasal sinus Paranasal sinus mass extending mass extending orbital fossaorbital fossa

Other paranasal sinus Other paranasal sinus lesionlesion

Few paranasal sinus lesions might causeFew paranasal sinus lesions might cause

eye problem or proptosis if the lesion is eye problem or proptosis if the lesion is severe severe

Paranasal sinusesParanasal sinuses

Thin wall Thin wall enhanced enhanced lobulated cystic lobulated cystic mass in both mass in both maxillary sinusesmaxillary sinuses

? Mucosal cyst ? Mucosal cyst

Paranasal sinusesParanasal sinuses

Air fluid level in Air fluid level in Rt. Maxillary Rt. Maxillary sinussinus

? sinusitis? sinusitis

Paranasal sinusesParanasal sinuses

Irregular mucosal Irregular mucosal thickening Lt.thickening Lt.

maxillary sinusmaxillary sinus Calcified mucosa Calcified mucosa

Rt. Maxillary Rt. Maxillary sinussinus

? Chronic sinusitis? Chronic sinusitis

Mass faceMass face

Mass Rt maxillary Mass Rt maxillary antrum, filling antrum, filling nasal cavity, nasal cavity, crossing midlinecrossing midline

? malignancy? malignancy

Mass faceMass face

AdvanceAdvance

malignancymalignancy

Rt. maxillaryRt. maxillary

antrumantrum

Intracranial massIntracranial mass

well enhancedwell enhanced

suprasellar masssuprasellar mass

involving Rt. Opticinvolving Rt. Optic

nerve?nerve?

meningiomameningioma

Same caseSame case

Huge mass Huge mass

with with

hydrocephalushydrocephalus

AVMAVM

dilated sup. dilated sup. Ophth.veinOphth.vein