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Intraorbital incidental findings
on MDCT: the importance of
looking at the eyes.
J. A. AGUILAR ARJONA, E. SANTOS ARMENTIA, G. TARDAGUILA DE
LA FUENTE, D. CASTELLON PLAZA, J. CALATAYUD MOSCOSO DEL
PRADO, R. VARELA PONTE
POVISA
Vigo
Objetive.

To show and describe the orbital
incidental findings on MDCT of the
brain.
Background



Intraorbital incidental findings are often found in
neurimaging studies.
Most of the cases are postsurgical changes.
However the type of surgery performed (bands of
silicone and metallic prosthetic material ....) are
not reflected properly in some cases in medical
reports.
Background


Alterations in the eye morphology produce usually
refractive defects, however, other incidental
findings not so common such as hemangiomas,
intraorbital dermoid tumors, varicose veins or eye
and orbital metastasis have a great impact on the
patient management.
A brief introduction of surgical techniques and a
review of intraorbital incidental findings seen on
MDCT are explained in this study.
Classification.
Infection.
 Inflamatory changes.
 Tumors.
 Vascular injuries.
 Posttraumatic and postsurgical changes.
 Calcifications and degenerative changes.
 Miscellaneous.

Infections
Infections
Patient with Diabetes Mellitus with endogenous endophthalmitis. There
is loss of sphericity of the globe with alteration of the postseptal and
preseptal fat and involvement of the lacrimal gland.
Infections
Chronic dacryocystitis with dacriolith.
Observe the collection in the inferomedial
edge with peripheral enhancement without
osseous affectation with widespread
trhough the nasolacrimal duct.
Bilateral haptics of
intraocular lens after
cataract surgery.
Infections
E. coli endophthalmitis with thickening and enhancement of
the peripheral portion of the globe with palpebral involvement
and thickening of the adjacent lateral rectus muscle.
Infections
As a consequence of endophthalmitis , observe the deformed
eyeball which is smaller than the other one. Partial calcification
of the lens is also present.
Infections
After 2 months.
Chorioretinitis VZV in a HIV patient with partial occupation of the posterior
camera. The differential diagnosis was performed with vitreous hemorrhage
or detachment, given a history of craneal traumatism.
Inflamation
Inflamation
Lesion surrounding the optic nerve with nodular and diffuse contrast
enhancement. The diagnosis meningioma or less likely glioma was
performed. 3 months late the patient was diagnosed of temporal arteritis
artery and corticosteroids were administered. In a control the lesion
decreased. It is an inflammatory pseudotumor associated with temporal
arteritis.
Tumors
Tumors
Choroidal metastasis. In the inferotemporal
region of the globe there is a solid,
hyperdense lesion in the basal study that
enhances. AP: breast cancer
Tumors
Metastasis. In the temporal part of the eyeball a solid, nodular lesion
that enhances intensely with contrast can be observed in a cerebral
CT for screening brain metastasis. AP: lung metastasis.
Tumors
Fibrous dysplasia. Lytic lesion of orbit
roof, with well defined and sclerosus
edges.
Tumors
Dermoid cyst. In the supero-nasal
region of the right orbit there is a
rounded heterogeneous lesion with
fat content is observed that pushes
the upper rectum muscle.
Tumors
Adenoma vs Hemangioma. Isodense nodular lesion on lacrimal
gland, that enhanced more than the gland.
Tumors
Dermoid cyst. Rounded hyperdense lesion in the internal
canthus of the right orbit, in the preseptal fat.
Tumors
Epidermoide vs Dermoid cyst. In the
anterior and superior orbital edge of the
left orbit there is a nodular lesion
isodense with hipodense areas inside
(fat density) that produce bone
remodeling with sclerotic rim.
Vascular
lesions
Vascular lesions
Hemangioma. There is a solid
extraconal lesion between the
superior and lateral rectus muscles
in the posterior portion of the orbit
with little phleboliths that enhances
with contrast and did not change
with Valsalva maneuver. No bone
erosion was observed.
Vascular lesions
Varicose veins. Solid lesion occupying the posterior portion of
the right orbit with a polylobulated morphology . Dynamic US
demonstrates that it increases with valsalva maneuver.
Vascular lesions.
Varicose veins. Solid lesion occupying the
posterior portion of the right orbit with
morphology polylobulated in contact with the
lower and the medial rectum muscles. The
mass enhances after contrast administration
and increases with valsalva maneuver.
Vascular lesions
Orbital hemangioma in the posterior
portion of the orbit, a solid lesion
with phlebolits that enhanced
weakely and did not change with
valsalva maneuver. No bone erosion
was observed.
Posttraumatics
and
postsurgical changes
Posttraumatics and postsurgical
changes
Absence of left eyeball with prosthesis.
Posttraumatics and postsurgical
changes
A
Posttraumatics
Left eyelid hematoma.
Lens dislocation. A dense biconvex image in the posterior
chamber with convex shape beyond their typical location.
Posttraumatics and postsurgical
changes
Aphakia. Absence of left lens.
Posttraumatics and postsurgical
changes
Calcifications. Probably post-traumatic or infectious.
Posttraumatics and postsurgical
changes
Absence of crystalline and presence of calcification in
relation to postsurgical changes.
Posttraumatics and postsurgical
changes
Silicone oil sealing of a retinal detachment.
Posttraumatics and postsurgical
changes
Ocular prosthesis
Posttraumatics and postsurgical
changes
Left globe evisceration and
placement of ocular prosthesis.
Posttraumatics and postsurgical
changes
Cataract surgery. Cataract extraction with implatation of an intraocular
lenses. The native human lens is readily seen on CT scans as an ovoid
mass suspended behind the plane of the iris with a relatively flattened
anterior surface and a convex posterior surface. The native lens appears
slightly hypedense. Intraocular lens consist of two components: An optical
lens component, called the optic, and footplates, called haptics, that are
used to maintain the optic in position. The haptics are hyperdense and
may be unilateral, or bilateral. The optic is isodense.
Posttraumatics and postsurgical
changes
Metal buckle ( high density) and silicone buckle( low density)
for retinal detachment.
Posttraumatics and postsurgical
changes
Metal buckle and sealed with intraocular silicone oil and mulitple
postsurgical changes.
Posttraumatics and postsurgical
changes
Metal buckle and silicone device in
retinal detachment.
Calcifications
and
degenerative changes
Calcifications and degenerative
changes
Calcification and thinning of
lens.
Calcifications and degenerative
changes
Phthisis bulbi. Calcification and left small eye. Phthisis bulbi referring to
a scarred, retracted, shrunken globe may be defi ned as a type of
secondary (developmental) microphthalmos. It is generally associated
with dystrophic calcification and may be the result of infection,
penetrating trauma, repeated orbital surgery, or noninfectious
inflammation.
Calcifications and degenerative
changes
Drusen of the optic nerve head. It consists of a primarily autosomal-dominant
preliminary mucoprotein matrix deposit with blurred papilla, but only
subclinical visual field deficits, and demonstrates calcification of the optic
head.
Calcifications and degenerative
changes
Calcification of optic nerve
It is an eccentric calcification
of the optic nerve of
unknown cause with no
visual disturbance.
Calcifications and degenerative
changes
Multiple punctate calcifications in
tendinous insertions of the rectus
muscles.
Calcifications and degenerative
changes
Trochlear calcification of
the superior oblique, which
is quite frequently.
Calcifications and degenerative
changes
Old abscess sealed with
llystoacryl .

Miscellaneous
Miscellaneous
Marfan Syndrome. Increased
anteroposterior diameter of
both eyeballs, bands of
silicone and surgery in both
lenses.
Miscellaneous
Subconjunctival fat herniation. Bilateral proptosis with
increased intraorbital fat and thickening of the inferior rectus
belly. Probably thyroid ophthalmopathy.
Miscellaneous
Small eye secondary to surgery
for abscess.
Miscellaneous
Farsighted. Increased transverse
diameter of the left eye.
Miscellaneous
Blind since birth. Observe the deformity
of the eyeball, with an increased AP
diameter.
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