Ocular adnexal IgG4-related disease: CT and MRI  findings

Song, Yong; Choung, Ho Kyung; Park, Sun Won; Kim, Ji-Hoon; Khwarg, Sang In; Jeon, Yoon Kyung

doi:10.1136/bjophthalmol-2012-302857

Cited by 36 publications

(23 citation statements)

References 27 publications

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“…Lacrimal glands were the most common orbital lesions, but extraglandular lesions such as medial canthus, extraconal space, extraocular muscles and lacrimal sacs were reported to be affected in IgG4-RD 16 17. In addition, enlargement of the infraorbital nerve and canal strongly suggests a diagnosis of reactive lymphoid hyperplasia or IgG4-RD in the presence of extraocular muscle enlargement or sinus disease 18.…”

Section: Discussionmentioning

confidence: 99%

IgG4-related disease in idiopathic sclerosing orbital inflammation

Lee

Woo

et al. 2015

Br J Ophthalmol

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IgG4-RD may be identified frequently in patients with ISOI, and distinguishing features may be bilateral lacrimal gland enlargement with associated submandibular gland enlargement. Patients with IgG4-RD may have better treatment outcomes with less aggressive treatment modalities than those with ISOI unrelated to IgG4. An additional workup for IgG4-RD should be considered in all histopathological biopsy specimens suspicious of ISOI.

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Section: Discussionmentioning

confidence: 99%

IgG4-related disease in idiopathic sclerosing orbital inflammation

Lee

Woo

et al. 2015

Br J Ophthalmol

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“…42 Ocular adnexal lesions exhibited well-defined margins, isoattenuation on precontrast CT studies, T1-isointense and T2-hypointense MRI lesions with a homogeneous internal architecture, enhancement patterns, and bone remodeling without destruction. 43 Pulmonary Involvement CT pulmonary lesions have been classified into 4 types: (1) thickening of bronchovascular bundles and interlobular septa (20 cases); (2) solid nodules resembling primary lung cancer (19 cases); (3) interstitial involvement (3 cases); and (4) round-shaped ground-glass opacities resembling bronchioloalveolar carcinoma (1 case). 20,44 Pleural effusions are unusual and seldom dominate the clinical picture, but pronounced pleural thickening is not uncommon.…”

Section: Ocular Involvementmentioning

confidence: 99%

Diagnostic Approach to the Complexity of IgG4-Related Disease

Stone

Brito-Zerón

Bosch

et al. 2015

Mayo Clinic Proceedings

154

224

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IgG4-related disease (IgG4-RD) is a systemic disease characterized by the infiltration of IgG4-bearing plasma cells and, more importantly, distinctive histopathological features: storiform fibrosis, obliterative phlebitis, a lymphoplasmacytic infiltrate, and mild-to-moderate tissue eosinophilia. The diagnostic approach is complex and relies on the coexistence of various clinical, laboratory, and histopathological findings, none of which is pathognomonic in and of itself. IgG4-related disease should be suspected in patients presenting with unexplained enlargement or swelling of 1 or more organs or tissue organs. Four laboratory abnormalities often provide initial clues to the diagnosis of IgG4-RD: peripheral eosinophilia, hypergammaglobulinemia, elevated serum IgE levels, and hypocomplementemia. Elevated serum IgG4 levels provided critical information in identifying the first cases of IgG4-RD, but recent studies have reported substantial limitations to the measurement of serum IgG4 concentrations, precluding reliance on serum IgG4 concentrations for diagnostic purposes. In contrast, new studies have suggested a promising role of flow cytometry studies in the diagnosis and longitudinal management of IgG4-RD. Demonstration of the classic histopathological features of IgG4-RD remains crucial to diagnosis in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. Of note, the multiorgan nature of IgG4-RD was first established in 2003. This review intends to provide most recent knowledge about the clinical, laboratory, radiological, and pathological characteristics of IgG4-RD that may guide the physician to establish an early diagnosis. We searched PubMed and MEDLINE for relevant articles published between January 1, 2000, and November 1, 2014, using the search terms IgG4 and IgG4-related.

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“…In 89% of patients with IgG4 RD, there is sinusal disease as well [24]. At imaging, orbital IgG4 RD lesions are diffuse or tumefactive, homogeneous, hypointense on T2-WI, enhancing, with no DWI restriction [37, 40]. Bone remodeling is possible [37].…”

Section: Characteristics Of Orbital Inflammation Due To Different Infmentioning

confidence: 99%

CT and MR imaging of orbital inflammation

et al. 2018

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PurposeOrbital inflammation can be idiopathic or in the context of a specific disease and it can involve different anatomical orbital structures. On imaging, inflammatory disease is frequently mistaken for infection and malignant tumors, and its underlying cause is often not determined. Through this article we aim to improve orbital inflammation diagnosis and underlying inflammatory diseases recognition.MethodsThe imaging protocols and characteristics of orbital inflammation were reviewed.ResultsA decision tree for the evaluation of these patients is provided. First, a combination of clinical and radiological clues is used to recognize inflammation, in particular to differentiate it both from orbital infection and tumor. Subsequently, different radiological patterns are recognized, often allowing the differentiation of the several orbital inflammatory diseases.ConclusionThe use of adequate imaging protocols and subsequent evaluation allow the recognition of an orbital lesion as inflammatory and the diagnosis of the underlying inflammatory disease. All in all, a proper treatment can be established, and at times, a biopsy can be avoided.

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Ocular adnexal IgG4-related disease: CT and MRI findings

Cited by 36 publications

References 27 publications

IgG4-related disease in idiopathic sclerosing orbital inflammation

IgG4-related disease in idiopathic sclerosing orbital inflammation

Diagnostic Approach to the Complexity of IgG4-Related Disease

CT and MR imaging of orbital inflammation

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