Computed tomography of orbital diseases in childhood

ABSTRACT

We anlized CT of 29 cases of various orbital disease in pediatric age group. Diagnoses were confirmed byeither operation or direct ophthalmoscopy. The patients were examined during the period of last 3 years. Theresults were as follows 1. Of 29 cases, 21 were male and 8 were female, and the age ranged from 20 days to 15years. 2. Intraorbital tumors were 13 cases consisting of 7 retinoblastoma, 3 pseudotumor, and 1 each ofcongenital teratoma, cavernous lymphanngioma, and optic glioma, Of remaining 16 cases, 6 had orbital fracture, 5persistent hyperplastic primary viterous(PHPV), 3 vitreous opacity, and 2 primary glaucoma. 3. The CT findings ofthe retinoblastoma were a lobulated or oval soft tissue mass denisty (40-60HU) extending into the vitreous wtihoutsignificant enhancement on postcontrast scan. Of 7 cases, 4 had calcifications within the tumors. The extraglobalextension of the tumor was shown in 2 patients demonstrating markedly thickened sclera with enhancement anddilated optic nerve. 4. There were 5 patients with PHPV having a history of white pupil since birth, and all wereaffected unilateraly. Four patients had vitreous opacity and 3 of those showed either linear or branchingtree-like densities within the vitreous on the postcontrast scan. Another one had a lobulated increased densityprotruding into the vitreous which was difficult to differenciate from the similar finding of retinoblastoma.Remaining one case demonstrated a deformed and decreased density in the lesional lens without chaneg in thedensity of the vitreous. This was confirmed to be caused by persistence of the embryonic hyaloid artery attachedto the posterior capsule of the lens. 5. There were 3 patients with vitreous opacity and 2 of them were due toretinal detachment and 1 was caused by retrolental fibroplasia. The CT findings of retinal detachement werehomogenous or heterogenous opacities in the vitreous. In a case of retrolental fibroplasia, irregular, band-likedensity was seen along the posterior wall of the globe bilaterally. 6. Two cases of primary glaucoma showed largeglobe with a widened anterior chamber. 7. Among 6 cases of orbital fractures, 5 were blow-out fracture. Theblow-out fractures showed fractures of the medial orbital wall or orbital floor with herniated intraorbitalcontents into the neighboring ethmoid or maxillary sinus.