Narváez CSJ, Biasotti FM

Language: Spanish
References: 11
Page: 257-263
PDF size: 281.78 Kb.

ABSTRACT

Introduction: It is the third more common pathology of eye orbit after thyroid orbitopathy (thyroid eye disease) and of lymphoproliferative disorders. Considered as a differential diagnosis in the orbital inflammations, it is worth to know about it. Causes and mechanisms are not yet well elucidated. Over the last decade, clinical entity has been better understood, assisted by imaging, immunopathogeny and molecular techniques.
Objective: Improving orbital pseudo tumor’s diagnostic precision with the analysis of clinico-radiological data of cases proven by histopathology.
Material and methods: Retrospective study of 12 patients classified with “inflammatory orbital pseudo tumor’s diagnosis·¡” (IOP) in the Radiology and Imaging Service of the Ophthalmology Institute (Instituto de Oftalmología Conde de Valenciana) in the period from January 2007 to September 2008. From the total, only six patients with pathological prove of the disease were included. Clinico-radiological findings and diagnosis prior to biopsy were analyzed.
Results: Six of the six patients had radiological and pathological IOP’S diagnosis. It is worth mentioning than in one of the six patients the radiological diagnosis was lymphoma vs. inflammatory pseudotumor. Radiological findings: Six patients showed lacrimal gland volume increase (in one patient, it was bilateral), five had proptosis, five showed extra-ocular muscles affectation, in three patients there were changes in the orbital grease density, three had intraconal visual compromise, two extraconal compromise and in two patients there was optic nerve affectation. Prior CT clinical diagnoses of the six patients were: One IOP, three with orbital tumor, one with lacrimal gland tumor and cellulites and the remainder did not have diagnosis written down in the file. Clinical findings: Six showed palpebral edema, in four we felt a tumor in the lacrimal gland (in one of them it was bilateral), in four we observed hyperemic bulbar, three showed proptosis (one was bilateral), three had ocular limited mobility, visual sharpness was importantly engaged in four patients and only one referred ocular pain with and without palpation.
Conclusion: IOP can clinically represent a diagnostic dilemma; however the computed CT is a method that correlated with clinical data proved to have a highly specific value for the evaluation and diagnosis of this pathology.

REFERENCES

1. Bosch J., Ortega-Aznar A, Tintore M, et al. Paquimeningitis hipertrófica. Revisión histórica a propósito de dos casos y relación patogénica con el síndrome de Tolosa-Hunt y pseudotumor orbitario. Rev Neurol 2000; 31(10): 946-51.

2. Hamad-Cueto O, Tamayo-Toledo JA. Mármol - Prado A. A., ed al Síndrome de Tolosa – Hunt y Pseudotumor Orbitario. Entidades solapadas en un caso con perfil clínico no habitual. Rev Neurol 2006; 42(9): 530-4.

3. Guzmán J, Mena I, Jiménez R, et al. Pseudotumor idiopático orbitario unilateral con extensión al seno cavernoso (síndrome de Tolosa-Hunt). Rev Oncol 2006; 16(1).

4. Otarola F, Flores JC. Pseudotumor inflamatorio de la órbita, caso clínico. Boletín Escuela de Medicina U.C. 2006; 31(1).

5. Yuen SJ, Rubin PA. Idiopathic Orbital inflammation: ocular mechanisms and clinopathology. Ophthalmol Clin North Am 2002; 15: 121-6.

6. Weeber A. Pseudotumor of the orbital. Clinical pathologic and radiology evaluation. Radiologic Clin of North Am Vol 1999; 37: 151-68.

7. Glenns, Forbes MD, Patrick F. ed al. Orbital Tumors Evaluated by Computed Tomography. Radiology 1980; 136: 101-11.

8. Lakshmana MD, Newman B. Shiresshan, at al. Inflamatori Pseudotumors. Radiographics 2003; 23: 719-29.

9. , Leuven BAL, Sartor K. Heidelberg. Imaging of Orbital and visual Pathawway Pathology. Springer-Verlag Berlin: Printed in Germany; 2006, p. 454.

10. Zegnel A, Zeynel A, Karcioglu, Hark G. Orbital tumors diagnosis and treadment. Springer Science, Business Media, Inc. 233 Spring Street, New York, USA: 2005, p. 234.

11. Som P, Hugh D. Curtion. Radiología de Cabeza y Cuello. 4a. Ed. edición en español. Madrid, España: Elsevier España, S.A.; 2004, p. 584-91