Orbital Muscle Enlargement: What if It’s Not Graves’ Disease?

Lakerveld, Mieke; Gijp, Anouk van der

doi:10.1007/s40134-022-00392-y

Cited by 8 publications

(3 citation statements)

References 59 publications

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“…Orbital emphysema is another radiological sign of anaerobic infection due to a path of communication between the infected maxillary sinus and orbit, allowing the spread of anaerobic bacteria such as the streptococcal species. When considering all causes of orbital cellulitis, the medial rectus is the most commonly affected muscle likely due to adjacent involvement of the ethmoid sinuses [45] (Supplementary Table 1). In contrast, half of the patients in our series presented with lateral rectus enlargement, which would be more consistent with an inferolateral pathway of pathogenic spread from the maxillary soft tissue, infratemporal fossa and inferior orbital ssure in OOC.…”

Section: Radiological Characteristicsmentioning

confidence: 99%

Clinical and radiological characteristics of odontogenic orbital cellulitis

Tumuluri,

Tong,

Tumuluri

et al. 2024

Preprint

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Purpose: To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis Method: Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes. Results: Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25-56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n=1, 25%), hand movements (n=1, 25%) and no perception of light (n=2, 50%). The organisms implicated were Streptococcus milleri (n=3, 75%) and Streptococcus constellatus (n=1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration. Conclusions: Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.

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Section: Radiological Characteristicsmentioning

confidence: 99%

Clinical and radiological characteristics of odontogenic orbital cellulitis

Tumuluri,

Tong,

Tumuluri

et al. 2024

Preprint

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“…Also contrast‐enhanced perfusion may be added to characterize lesions. 43 , 72 CT scans also demonstrate orbital pathology, in particular of bony origin. In MRI, there is a difference between quantitative and qualitative scans.…”

Section: Imaging Of Extra‐ocular Musclesmentioning

confidence: 99%

“…Besides anatomic sequences (T1 weighted [T1w] and T2 weighted [T2w] images) functional sequences such as diffusion weighted imaging (DWI), reflecting the Brownian motion of water molecules and thereby sensitivity to tissue architecture. Also contrast‐enhanced perfusion may be added to characterize lesions 43,72 . CT scans also demonstrate orbital pathology, in particular of bony origin.…”

Section: Imaging Of Extra‐ocular Musclesmentioning

confidence: 99%

Clinical and imaging clues to the diagnosis and follow‐up of ptosis and ophthalmoparesis

Keene

Kan

Meeren

et al. 2022

J cachexia sarcopenia muscle

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Ophthalmoparesis and ptosis can be caused by a wide range of rare or more prevalent diseases, several of which can be successfully treated. In this review, we provide clues to aid in the diagnosis of these diseases, based on the clinical symptoms, the involvement pattern and imaging features of extra‐ocular muscles (EOM). Dysfunction of EOM including the levator palpebrae can be due to muscle weakness, anatomical restrictions or pathology affecting the innervation. A comprehensive literature review was performed to find clinical and imaging clues for the diagnosis and follow‐up of ptosis and ophthalmoparesis. We used five patterns as a framework for differential diagnostic reasoning and for pattern recognition in symptomatology, EOM involvement and imaging results of individual patients. The five patterns were characterized by the presence of combination of ptosis, ophthalmoparesis, diplopia, pain, proptosis, nystagmus, extra‐orbital symptoms, symmetry or fluctuations in symptoms. Each pattern was linked to anatomical locations and either hereditary or acquired diseases. Hereditary muscle diseases often lead to ophthalmoparesis without diplopia as a predominant feature, while in acquired eye muscle diseases ophthalmoparesis is often asymmetrical and can be accompanied by proptosis and pain. Fluctuation is a hallmark of an acquired synaptic disease like myasthenia gravis. Nystagmus is indicative of a central nervous system lesion. Second, specific EOM involvement patterns can also provide valuable diagnostic clues. In hereditary muscle diseases like chronic progressive external ophthalmoplegia (CPEO) and oculo‐pharyngeal muscular dystrophy (OPMD) the superior rectus is often involved. In neuropathic disease, the pattern of involvement of the EOM can be linked to specific cranial nerves. In myasthenia gravis this pattern is variable within patients over time. Lastly, orbital imaging can aid in the diagnosis. Fat replacement of the EOM is commonly observed in hereditary myopathic diseases, such as CPEO. In contrast, inflammation and volume increases are often observed in acquired muscle diseases such as Graves' orbitopathy. In diseases with ophthalmoparesis and ptosis specific patterns of clinical symptoms, the EOM involvement pattern and orbital imaging provide valuable information for diagnosis and could prove valuable in the follow‐up of disease progression and the understanding of disease pathophysiology.

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