A Clinical Update and Radiologic Review of Pediatric Orbital and Ocular Tumors
Figure 4
18-year-old male presenting with right sided proptosis and history of choroid plexus papilloma and seizures. Axial CT soft-tissue window (a) shows a soft-tissue mass centered in the right ethmoid sinus with bony destruction and invasion into the right orbit and left ethmoid sinus. Coronal CT image using bone windows (b) clearly demonstrates the osseous destruction and invasion of the right medial orbital wall, bilateral ethmoid sinuses, right frontal sinus, both nasal cavities, turbinates, and nasal septum. Postcontrast axial (c) and coronal (d) T1-weighted images with fat saturation better demonstrate the enhancing soft-tissue mass and its extension. The mass invades the medial orbit, displacing the right medial rectus laterally (black arrow), and causes proptosis (star). On coronal, the mass is again seen invading the adjacent sinuses and obstructing the nasal passage; however, unlike CT, abnormal enhancement is seen of the frontal dura (white arrows). The dural thickening and enhancement are compatible with direct tumor invasion. These findings were highly concerning for rhabdomyosarcoma. On postchemotherapy followup imaging (e), the tumor has significantly decreased in size with decreased mass effect on the orbit and adjacent structures. The previously seen dural enhancement has been resolved; however, some residual tumor remains in the paranasal sinus inferomedial to the orbit (white arrow).
