Orbital Imaging

260 Pages·2014·11.645 MB·English

by  F. Allan Midyett, Suresh Kumar Mukherji

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ORBITAL
IMAGING
F. Allan Midyett, MD, DABR
Neuroradiologist
Department of Radiology
Howard University Hospital
Washington, D.C.
Suresh K. Mukherji, MD, MBA, FACR
Professor and Chairman
Walter F. Patenge Endowed Chair
Department of Radiology
Michigan State University
East Lansing, Michigan
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ORBITAL IMAGING ISBN: 978-0-323-34037-3
Copyright © 2015 by Saunders, an imprint of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluat-
ing and using any information, methods, compounds, or experiments described herein. In using such
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parties for whom they have a professional responsibility.
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contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Midyett, F. Allan, author.
Orbital imaging / F. Allan Midyett, Suresh K. Mukherji.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-34037-3 (pbk. : alk. paper)
I. Mukherji, Suresh K., author. II. Title.
[DNLM: 1. Orbital Diseases—diagnosis. 2. Diagnostic Imaging. 3. Orbit—injuries. WW 202]
RE711
617.7’807572—dc23
2014038261
Content Strategist: Helene T. Caprari
Content Development Specialist: Amy Meros
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Carol O’Connell
Design Direction: Brian Salisbury
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
First, this book is dedicated to my children, Scott,
Laura, and Brian, who probably never
understood why I spent so much time on radiology.
Then, to my parents, who were convinced that
all those years of education and training would
eventually bear fruit.
Then, to all those patients with cancer who will
probably never understand the important role
radiologists and ophthalmologists play in early
diagnosis and proper treatment of their very
personal disease.
Then, to my faithful friends Cooper and Vana
(the Vizslas) who unequivocally never
understand why I waste “valuable” time sitting
at the computer when I could be playing with them.
And last but not least, to my darling wife
Diane, who always understands each and every
day how very how much this book means to me.
Preface
Orbital Imaging was created to serve as a handy As my interest in correlation between radio-
reference and learning text. It was meant to logic imaging and gross pathology runs long and
answer questions created by that “funny eye deep, I couldn’t resist the opportunity to share a
case” and to whet the reader’s appetite for more. few gross pathology images with the reader, in
It was envisioned as a book that the reader could the hope that this correlation cements the image
start in the airport and read all the way through in your psyche.
or start in middle and read a single chapter. Or The orbit has a rich and long history dating
better yet, read all the way through during the back hundreds and even thousands of years. The
flight and then come back to relook at a certain subsection “Historic Highlights” hopefully will
chapter when the reader encounters that unusual be one that will be of interest to many when
orbital case. making a casual read through. When the book is
I wanted to present pertinent orbital patholo- used as a quick reference for that eye case that
gies that included those entities we see every day, has to be discussed with the clinician right now,
those entities we see mostly on board examina- this is one of the first sections to skip.
tions, and some entities that are rare as hen’s The differential section has been written
teeth but some say we are “supposed to know” with great care. I have tried to find contrasting
when we see them. findings to help you tell the difference, if these
I wanted to give the reader a complete, points can be found. Sure, some of these are
although “thumbnail,” sketch in a format that really “Aunt Minnies” and if they are, we say so.
hopefully could be easily remembered. I wanted But some of these differentials are really tough,
to package the individual components in a logi- and I believe this section is potentially helpful,
cal fashion so that the reader could first and imparting wisdom usually found from our
foremost quickly find the section he or she is prized professors. Well, we did get a lot of it
looking for. But even more important I wanted from them.
the reader to be able to quickly identify the sec- But most of all, I wanted to make this text-
tion not wanted to be reviewed at any particular book one that readers would enjoy reading and
time. find that certain sections just stuck in their
I wanted to depict those images that best minds. Yes, in some ways this text takes a sim-
demonstrated the pathologic entity with the best plistic approach. You will find the statistics and
imaging sequences. Some of these cases are truly the nomenclature have been rounded off. To the
“rare birds,” and we brought you the best images big book purists, I apologize. To those of you
we had available. But imagine the esthesioneuro- who seek the sleeker approach, I do hope you
blastoma, an entity that has only been reported learn something, find something to remember,
1000 times since it was first described in 1924 by and enjoy reading it!
Berger and Luc. We had five cases to choose
from, and we show four in this text. F. Allan Midyett, MD
iv
Acknowledgments
As I look back on a long and exciting career in And to top all this, I had the fabulous oppor-
radiology, I always remember first and foremost tunity to do my neuroradiology fellowship with
the impressive radiology showman David S. Mauricio Castillo and Suresh Mukherji, and I
Carroll, who caused me to say “Wow, I can’t caught a glimpse of academic neuroradiology
believe he can read all that from the radio- like I never saw it before. Their level of expertise
graph!” And then I just had to go into radiology. blew my mind, and in the process I developed a
Then I learned that Dr. Carroll really was a love for head and neck radiology, and specifically
great radiologist, but he was a fantastic show- orbital imaging.
man! While Dr. Carroll’s list of accomplish- Suresh Mukherji has been an incredible men-
ments was longer than this acknowledgement, it tor for me in my fellowship, and has proven to
was his showmanship that caused me and others be an invaluable co-author of Orbital Imaging.
to go into radiology. And then I settled down to I would like to thank the fabulous folks at
learn under the watchful tutelage of C. Allen Elsevier, including (but not limited to) Helene
Good. No one ever accused Dr. Good of being a Caprari, Amy Meros, Kathryn DeFrancesco, and
showman, just as no one doubted he was an ex- Carol O’Connell.
ceptional radiologist. Dr. Good set superb stan- And while my almost half century in radiol-
dards for the practice of radiology both at the ogy has taught me that we can’t all be like Dave
Mayo Clinic and for the entire country during Carroll and dazzle people all the time, I will
his more than a quarter century leading the submit that these are some of my most memo-
American Board of Radiology as its president rable moments in radiology. I do hope you enjoy
and secretary. the book and go out and dazzle someone some-
My mentors are TNTC (Too Numerous to time with what you have learned from Orbital
Count). Many, like Bob Scanlon, Dave Reese, Imaging.
Colin Holman, Hillier L. “Bud” Baker, and oth-
ers, have relocated and are currently watching F. Allan Midyett, MD
over us from on high.
v
CONTENTS
19 76
• PART I R£TINOBLASTOMA,
TRAUMA AND SURGERY 20 ORBITAL LEUKEMIA, 80
1 MEDIAL BLOWOUT FRACTURE, 3 21 OPTIC NERVE METASTASIS, 87
2 BLOWOUT ORBITAL FLOOR FRACTURE, 9 22 EsTHESIONEUROBLASTOMA, 91
3 ORBITAL ExENTERAT10. , 14 23 RHA8DOMYOSARCOMA, 99
4 ORBITAL FLOOR MESH, 18
• PART IV
5 ANTERIOR CHAMBER P ERFORATION, 20
CONGENITAL
6 OCULAR LENS DISPLACEMENT, 23
24 CoLOBOMA, 105
7 RUPTURED GLOBE, 26
25 P ERSISTENT H YPERPLASTIC PRIMARY
8 PHTHISIS BULBI, 29 VITREOUS, 112
9 O CULAR PROSTHESIS, 32 26 CONGENITAL ORBITAL TERAT0.\1.A, 116
10 RETINAL DETACHMENT, 35 27 CONGENITAL A.NOPHTHALMIA, 121
• PART II
• PART V
BENIGN TUMORS
VASCULAR
11 ORBITAL CAVERl ous HEMANGIOMA, 41 28 CAROTID-CAVERNOUS FISTULA, 127
12 44
OPTIC NERVE GLIOMA, 29 CAVERNOUS SINUS THROMBOSIS, 133
13 OPTIC TERVE MENINGIOMA, 48 30 ORBITAL VENOUS VARIX, 139
14 POSTERIOR ORBITAL DERMOIDS, 54 31 VE ous LYMPHATIC M ALFORMATION, 143
15 ORBITAL LIPOMA, 57
16 ORBITAL SCHWAN OMA, 59 • PART VI
DEGENERATIVE
• PART III 32 PosTERIOR O cuLAR STAPHYLOMA, 149
MALIGNANT TUMORS
33 CATARACTS: BEFORE AND AFTER, 153
17 O CULAR AnNEXAL LYM PHOM A, 65 34 OPTIC Disc DRUSEN, 156
18 OcuLARMELANOMA, 71
vi
CONTENTS Vii
• PART VII • PART X
MUSCLE CONE INFLAMMATORY
35 GRAVES 0RBITOPATHY, 161 44 ORBITAL ABSCESS, 207
36 IDJOPATHIC ORBITAL PsEUDOTUMOR, 166 45 CYTOMEGALOVIRUS RETINITIS, 211
46 PoTT's PuFFv TuMoR, 215
• PART VIII
OPTIC PATHWAY
• PART XI
UNCERTAIN ETIOLOGY
3 7 OPTIC NERVE EURITIS, 17 5
38 OPTIC NERVE LEUKEMIA, 178 47 PswDoTUMOR CEREBRJ, 223
48 WEGENER GRA1 ULOMATOSlS, 22 7
• PART IX
LACRIMAL GLAND
• PART XII
39 LACRIMAL GLAND SARCOIDOSIS, 185 BONY ORBIT
40 LACRIMAL GLAND LYMPHOMA, 188 49 ORBITAL PLASMACYTOMA AND
MYELOMA, 233
41 LACRIMAL GLAND DERMOID, 191
50 FrnRous DvsPLASIA, 241
42 ADENOID CYSTIC CARCINOMA
OF THE LACRIMAL GLAND, 194 ABBREVIATIONS 247
43 SQUAMOUS CELL CARCINOMA
OF THE LACRIMAL SAC, 200
PART I
TRAUMAAND
SURGERY
PART OUTLINE
1 Medial Blowout Fracture 3
2 Blowout Orbital Floor
Fracture 9
3 Orbital Exenteration 14
4 Orbital Floor Mesh 18
5 Anterior Chamber Perforation 20
6 Ocular Lens Displacement 23
7 Ruptured Globe 26
8 Phthisis Bulbi 29
9 Ocular Prosthesis 32
10 Retinal Detachment 35
1