Differential Diagnoses of Diseases Involving the Extrinsic Ocular Musculature ­ A Pictorial Essay

Introduction There are some inflammatory, infectious, and neoplastic diseases affecting the extrinsic orbital musculature (EOM) that present with pain, decreased visual acuity, and proptosis. Imaging is fundamental to the differential diagnoses of these diseases with similar clinical presentations. The present case series report has as main objective to illustrate and discuss the main pathologies that affect the orbit. Material and Methods The present series of cases discusses the main pathologies that can affect the extraocular musculature that can be characterized by computed tomography (CT) or magnetic resonance imaging (MRI) using cases from our institution. Results and Discussion The present study compiled several cases of ophthalmopathy from our institution to illustrate and address some of these pathologies, such as orbital lymphoma, Grave disease, metastases, periorbital cellulitis, and idiopathic orbital inflammatory syndrome. The diseases are discussed according to the presentation of clinical cases with emphasis on the main imaging findings of each pathology. Conclusion Computed tomography and MRI can help in the diagnosis and follow-up of the diseases that affect the EOM. We must be conversant with the main characteristics of the pathologies presented in the present case series report, since such findings together with clinical data can confirm the diagnosis of these diseases or at least help to narrow the differential diagnoses.

Mucormicosis rino-órbito-cerebral crónica: una patología poco frecuente / Chronic rhino-orbital-cerebral mucormycosis: an uncommon pathology

Resumen La mucormicosis rino-órbito-cerebral (ROC) crónica es una patología poco frecuente, con un número reducido de casos publicados en la literatura, cuyas manifestaciones son muy diversas e inespecíficas. El tratamiento se basa en la experiencia de casos y series de casos. Las herramientas terapéuticas incluyen el uso de antifúngicos endovenosos y orales por tiempo prolongado, asociado o no a debridamiento quirúrgico amplio, pudiendo requerir incluso exenteración orbitaria. Presentamos a continuación un caso de mucormicosis ROC crónica, junto con las dificultades para su diagnóstico y manejo, en el que destaca el enfrentamiento multidisciplinario. Dada la poca frecuencia de esta enfermedad, nos parece relevante difundirlo.

Abstract Chronic rhino-orbital-cerebral mucormycosis is a rare condition with a small number of cases that have been published, whose manifestations are very diverse and nonspecific. The treatment is based on case series experiences. Therapeutic options include the use of long-term intravenous and oral antifungals, associated or not with extensive surgical debridement, and may even require orbital exenteration. We present below a case of chronic rhino-orbital-cerebral mucormycosis with the challenge of diagnosis and management in which multidisciplinary work is fundamental. Since it is an uncommon pathology, it seems relevant to share the information.

Complicación orbitaria recurrente por rinosinusitis. Reporte de un caso / Recurrent orbital complication by rhinosinusitis. A case report

El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis.La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base.Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.

Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process.This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis.Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention

Aspectos tomográficos da órbita aguda infecciosa: revisão de literatura / Tomographic findings of acute infections of the orbit: literature review

As doenças que acometem a órbita de forma aguda e não traumática por vezes não são conhecidas por médicos em centros de emergência. Essas condições são decorrentes de diversos fatores, como desordens imunológicas, congênitas, infecciosas, vasculares, entre outras. As causas infecciosas correspondem a mais de 50% de todos os casos e requer rápido diagnóstico e conduta para minimização de sequelas. A tomografia computadorizada (TC) é o exame de imagem de primeira linha nesses casos, sendo geralmente disponível nos centros de emergência e capaz de fornecer auxílio diagnóstico de forma rápida, precisa e eficaz. Esse artigo de revisão visa descrever os principais aspectos tomográficos da órbita aguda infecciosa, correlacionando-os com os dados da literatura.

The acute and nontraumatic diseases that involve the orbit are often little known by most physicians. These conditions are due to several factors, such as immune disorders, congenital, infections, vascular, among others disorders. The infectious causes correspond to more than 50% of all cases and require rapid diagnosis and management in order to minimize sequels. Computed tomography (CT) is the first line imaging method on these cases, generally being available in emergency centers and capable to provide an accurate, quick and effective diagnostic information. This review article aims to describe the main tomographic findings in acute orbit infections, correlating them with the literature data.

Clinical and surgical treatment of secondary orbital abscess in ethmoidal sinusitis / Tratamento clínico e cirúrgico de abscesso orbital secundário a sinusite etmoidal

The authors report the case of na eighteen years old patient with a clinical picture of orbital abscess caused by ethmoid sinusitis. The decision for surgical intervention results from correlation between clinical findings and from the image diagnosis.

Relato de um caso de uma paciente de 18 anos com um quadro clinico de abscesso orbital causado por sinusite etmoidal. A decisão pela intervenção cirúrgica resultou da correlação entre achados clínicos e do diagnóstico dos exames de imagem.