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Intraorbital ExtraconalConal Intraconal Globe.

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Presentation on theme: "Intraorbital ExtraconalConal Intraconal Globe."— Presentation transcript:

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12 Intraorbital ExtraconalConal Intraconal Globe

13 IntraorbitalIntraorbital ExtraconalExtraconal ConalConal IntraconalIntraconal GlobeGlobe Lacrimal glandLacrimal gland

14 Supraorbital fissure Infraorbital fissure and pterygopalatine fossa Supraorbital fissure

15 Variant

16 Muscles

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18 Orbita may be easily affected!!!

19 Fossa pterygopalatina Close relation Orbit-PNS- Oropharynx Nerves III, IV, V, VI, VII Parasellarregion Maxillary nerve Greater petrosal nerve

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21 Inflammation of lid CT (Abscess) MRI (Phlegmone)

22 –Spread of infection from ethmoid cells –Compression of optic nerve –Thrombosis –Spread of infection from ethmoid cells –Compression of optic nerve –Thrombosis Harnsberger R: Head and Neck 2004

23 -Spread of infection from ethmoid cells -Compression of optic nerve!! -Thrombosis!! -Spread of infection from ethmoid cells -Compression of optic nerve!! -Thrombosis!! Harnsberger R: Head and Neck 2004

24 Dacryoadenitis

25 The inflammation involved the medial extraconal portions of the right orbit Axial CT scan shows lateral displacement of the medial rectus muscle and infiltration ofthe extraconal fat (arrows) The inflammation involved the preseptal and extraconal portions of the medial right orbit. Axial CT scan shows the slightly displaced and thickened medial rectus muscle and a small focal fluid collection (arrow), which was confirmed as representing a subperiosteal abscess

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27 Axial CECT shows a diffuse infiltrative right orbital mass involving the globe and causing marked proptosis Diffuse enlargement of the lacrimal gland is seen with preservation of its shape There is diffuse thickening of the bilateral medial and lateral rectus muscles including their tendinous insertion (arrows) which is typically spared in thyroid ophthalmopathy

28 Optic nerve neuritis (MS)

29 3T Orbital pseudotumor No diffuse infiltration

30 Graves disease / M. Basedow

31 Endocrine orbitopathy MR Graves disease / M. Basedow

32 Endocrine orbitopathy 3T MR Thickening and hyperintensity of medial and inferior rectus muscle

33 Small capillary hemangioma

34 3T MR Large capillary hemangioma

35 Hemangiomatosis

36 3T MR Large lymphatic- venous malformation

37 Axial CT scan reveals a multilocular intraconal lymphangioma in the right orbit. Lymphangioma in a patient who experienced sudden proptosis and discoloration about his right eye Lymphangioma in a patient who experienced sudden proptosis and discoloration about his right eye

38 USG reveals a multiseptate cystic mass in the orbit MRI reveals a heterogeneous intraconal mass in the right orbit displacing the optic nerve. Lesion is heterogeneous in signal intensity with a hyperintense area on T1W image (a) which shows blood-fluid level on T2W sequence (arrows) (b). There is only mild enhancement following contrast administration (c) MRI reveals a heterogeneous intraconal mass in the right orbit displacing the optic nerve. Lesion is heterogeneous in signal intensity with a hyperintense area on T1W image (a) which shows blood-fluid level on T2W sequence (arrows) (b). There is only mild enhancement following contrast administration (c)

39 Bone Lacrimal gland Conus (Globe) Nerve Fibrous dysplasia, Metastasis Adenoma, Dermoid, pleomorphic Adenoma, Lymphoma Grave`s, Hemangioma, Lymphoma, Schwannoma, Pseudotu (Melanoma, Retinoblastoma) Glioma, Meningeoma P. Som Head and Neck Imaging 4th ed. 2003

40 Fibrous dysplasia orbit

41 Melanoma lower lid

42 Dermoid Fat

43 3T MR Pleomorphic adenoma

44 parotid gland

45 MALT-lymphoma lacrimal gland

46 Orbital lymphoma diffuse infiltration

47 Rhabdomyosarcoma

48 3T MR Rhabdomyosarcoma M. rectus superior

49 Rhabdomyosarcoma

50 Cavernous hemangioma

51 Axial T1W and T2W MRI reveal an elongated lesion around the optic nerve which is hypointense on T1W and hyperintense on T2W sequence. Note the characteristic club like configuration of the lesion in the sagittal T2W

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74 Axial CECT shows an intensely enhancing mass in the eyelid and extraconal space of the left orbit causing displacement of the globe

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76 A homogenous well-defined intraconal mass is seen in the left orbit which is isointense on T1W, hyperintense on T2W sequence and reveals heterogeneous enhancement. Cavernous hemangiomas are not uncommon in children A homogenous well-defined intraconal mass is seen in the left orbit which is isointense on T1W, hyperintense on T2W sequence and reveals heterogeneous enhancement. Cavernous hemangiomas are not uncommon in children

77 Optic nerve meningeoma Tram-track

78 Glioma II

79 3T MR Glioma II

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83 Axial CT scan reveals bilateral calcified meningiomas ofthe optic sheath Axial CT scan shows diffuse involvement of the right optic nerve by a glioma. Pediatric optic nerve gliomas are frequently associated with neurofibromatosis

84 Schwannoma III

85 Schwannoma V2 with elevation of rectus inf. muscle

86 Angiofibroma with orbital infiltration

87 SCC

88 Le Fort II

89 Orbital floor-fx with herniation of fat

90 Hematoma

91 Orbital floor fracture, Motility disturbance

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93 Foreign body sclera

94 Perforating intraocular fb

95 Remind anatomic situation Imaging technique and characteristics and localisation of pathology (intraorbital compartments) Involvement of adjacent structures Careful analysisDIAGNOSIS

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97 Axial CT scan demonstrates a calcified mass in the left globe, accompanied by some increased attenuation of the vitreous.

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101 Axial contrast material-enhanced CT scan shows a coneshaped, noncalcified, central retrolental area of increased attenuation in the right eye Coronal T2/W MR image better depicts this abnormality. The increased signal intensity in the right globe is due to hemorrhage

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103 The infant, born prematurely, had received oxygen therapy for respiratory distress syndrome. Axial CT scan clearly shows the high- attenuation detached retinas (arrows). Axial CT scan shows a uniform increased attenuation throughout the right globe. The linear area of high attenuation seen in the middle to lateral aspects of the globe is a detached retina. A classic nematode infection was confirmed at the histopathologic analysis. The lack of a focal mass and of calcification helps differentiate sclerosing endophthalmitis from retinoblastoma.

104 Color doppler USG shows a large retinal detachment with hypoechoic subretinal exudates CT shows diffuse increase in the intraocular density

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106 Axial CECT show a homogeneous multicompartmental soft tissue density mass causing orbital expansion and destruction of the medial orbital wall

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108 Axial CT scan shows preseptal swelling and involvement the left orbit, diffuse scleral thickening with enhancement, and a poorly defined intraconal mass that envelops the optic nerve. There is resultant proptosis. Axial CT scan shows preseptal swelling and involvement the left orbit, diffuse scleral thickening with enhancement, and a poorly defined intraconal mass that envelops the optic nerve. There is resultant proptosis.

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110 Axial CECT shows destruction of lateral orbital walls and the greater wing of the sphenoid bone on both sides with associated complex soft tissue mass encroaching on the orbits. The skull radiograph in the same patient reveals multiple well- defined lytic lesions in the cranial vault with typical bevelled edges

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122 Axial CECT shows defect of the right globe at the optic nerve head via which the vitreous projects posteriorly (arrow). The left globe is small, with a retrobulbar (colobomatous) cyst (arrow) and dystrophic calcification at the site of coloboma

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124 Axial CECT shows a large right orbital cyst with absence of the globe. Also note the microphthalmia with coloboma and dysplastic lens on the left side

125 Sagittal midline T1/W MR image demonstrates agenesis of the corpus callosum and a prominent anterior inferior recess ofthe third ventricle (arrow). Axial T1/W MR image shows bilaterally small globes (left larger than the right), with hemorrhage in the left globe. Since no trauma had occurred, the presence of hemorrhage may indicate PHPV is present

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128 Anterior radiograph of the skull demonstrates the typical features ofApert syndrome Axial CT scan demonstrates the proptosis and shallow orbits

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