0:00

This was the case of a gentleman who complained of

0:05

sinus congestion as well as bilateral proptosis.

0:10

The axial scans, as we scroll through the brain, show

0:14

complete opacification of the ethmoid sinuses.

0:18

And we note that the patient has had previous surgery on

0:23

the maxillary antrum with medial antrostomies, and there is

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mucosal thickening bilaterally in the maxillary

0:29

antrum at the superior portion of the orbit.

0:34

We notice that there is an abnormality which

0:36

is seen medial to the medial rectus muscle.

0:42

The muscle is seen displaced inward, and when we think

0:48

of all comers, we might suggest that this could be an

0:51

infectious etiology secondary to the ethmoid sinusitis.

0:56

But let's look at the case a little bit

0:58

more carefully on the coronal images.

1:00

On the coronal images, we note that this collection is

1:05

actually far superior in the orbit, in the superior medial

1:09

aspect of the orbit and not directly

1:12

adjacent to the ethmoid sinus.

1:15

The abnormality is low in density and it's seen between

1:19

the superior rectus muscle and the inferior rectus muscle.

1:24

Not only that,

1:25

but it seems to extend into the orbital roof along the

1:28

expected location of the Levator palpebrae muscle.

1:34

Looking at the bone windows,

1:37

we note that there is thickening of the bone in the

1:40

orbital roof and that in point of fact there is diffuse

1:45

abnormality in the density of the skull base.

1:48

The pterygoid bones,

1:50

as well as the walls of the sphenoid, are abnormal.

1:54

If we allow our eyes to stray down to the mandibles, we

1:59

also see that there is bony reaction along the mandible

2:03

with abnormal density not only in the mandible,

2:06

but along the pterygoid bones and even along portions of

2:10

the temporal bone and the anterior clinoid process.

2:15

This patient has diffuse metastatic disease to the bone

2:19

from prostate cancer, and this extraconal abnormality is

2:24

actually extraosseous tumoral infiltration of the orbit

2:30

by the bone metastases, rather than a manifestation of the

2:35

perinasal sinusitis. So that sinusitis was coincidental,

2:40

but the abnormality was diffuse metastatic disease to bone

2:45

with extraosseous extension into

2:48

the extraconal space.