Orbital inflammatory syndromes with systemic involvement may mimic metastatic disease.
Physical examination of a 9-year-old girl with a 2-month history of swelling of the left orbit demonstrated an orbital mass, blepharoptosis, and proptosis. Computed tomography revealed a 2 x 3-cm mass in the superior left orbit that expanded orbital dimensions. Radiography showed abnormalities in the parietal and frontal bones and distal right tibia. Magnetic resonance imaging demonstrated an 8.5-cm abnormality of the marrow space of the right mid-tibia. Bone marrow biopsy was unremarkable. Orbital and tibial biopsies showed a nonspecific chronic inflammation. Idiopathic inflammation that involves the orbit (orbital pseudotumor) and that has systemic manifestations may mimic more serious conditions, such as metastases from rhabdomyosarcoma or Ewing sarcoma, chronic recurrent multifocal osteomyelitis (CRMO), and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis). Accurate diagnosis requires careful clinical and pathologic examinations.
Foley
Melanie R
MR
Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Moshfeghi
Darius M
DM
Wilson
Matthew W
MW
Haik
Barrett G
BG
Pappo
Alberto S
AS
Hill
D Ashley
DA
D001763:Blepharoptosis / Q000175:diagnosis; D001847:Bone Diseases / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D003937:Diagnosis, Differential; D005094:Exophthalmos / Q000175:diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D009362:Neoplasm Metastasis; D016727:Orbital Pseudotumor / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D011877:Radionuclide Imaging; D013577:Syndrome; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids; D011241:Prednisone