Abstract
A previously healthy 46-year-old female patient presented to the Emergency Department (ED) with a primary complaint of binocular diplopia worsening over the past 48 hours. Physical exam revealed minor left inferior lid ecchymosis and was significant for proptosis (Figure 1a). There was no pain on extraocular movements, erythema of either lid, induration, chemosis, ophthalmoplegia, relative afferent pupillary defect, or other features of orbital cellulitis. Point of care ultrasound (POCUS) of the globe and orbit was performed and demonstrated a hypoechoic mass within the left lateral rectus muscle (Figure 1b; online Video S1). The patient had orbital CT and MRI imaging revealing, “Two enhancing masses within the left orbit adjacent to or arising from the left lateral rectus muscle causing mild medial displacement of the left optic nerve and mild left proptosis. No evidence of extra orbital extension or perineural spread. Imaging findings nonspecific…”
Highlights
A previously healthy 46-year-old female patient presented to the Emergency Department (ED) with a primary complaint of binocular diplopia worsening over the past 48 hours
Orbital malignancy and localized presentations of systemic autoimmune conditions can be expected to have a wide variety of Point of care ultrasound (POCUS) findings representative of their underlying pathology
While there are no sonographic pathognomonic features of idiopathic orbital inflammation (IOI), POCUS confirmed the presence of a unilateral asymmetric orbital mass affecting the left lateral rectus muscle, thereby refining the differential diagnosis and streamlining the subsequent advanced imaging studies
Summary
01 | POCUS J | 5 symmetrical thickening of the ocular muscles without discrete mass[3]. Orbital malignancy and localized presentations of systemic autoimmune conditions can be expected to have a wide variety of POCUS findings representative of their underlying pathology. A diagnosis of idiopathic orbital inflammation (IOI) was suspected based on the clinical history, physical examination and initial imaging findings.
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