Season 5 Case 22

History: left eye pain, diplopia

Season 5 Case 22

History: History: left eye pain, diplopia

all-3


Answer:

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So there is obvious left occular abnormality, correct? And it is superiorly located in the orbit, with enlargement of the superior rectus muscle with some surrounding stranding.

Answer: orbital pseudotumor (although given the images you have, thyroid opthalmopathy is a good option as well).

Remember the main difference: Pseudotumor INVOLVES the tendons of the extraoccular muscles while thyroid opthalmopathy classically is confined to the muscle belly and given that it is related to mucopolysaccaride deposition, the muscles bellies classically decrease in density, with associate increased in the amount of intraorbital fat.

And if you like pneumonics, Thyroid eye disease involves the EOMs classically in the “I’M SLOW” sequence (unless it doesn’t of course)

ref: https://radiopaedia.org/articles/orbital-pseudotumour

https://radiopaedia.org/articles/thyroid-associated-orbitopathy