Case 2

This is CT study of the brain and facial bones. It shows marked bony hyperostosis of the lesser and greater wings of the sphenoid bone on the right side. Adherent to the inner surface of the bone is an extra-axial soft tissue mass, showing an ‘en plaque’ configuration and extending from the intra-cranial para-sellar region, through the superior orbital fissure into the right orbit. This is causing significant proptosis of the right globe.

Incidentally noted right ethmoid sinusitis.

The findings are characteristic of a spheno-orbital meningioma.

The differential diagnosis includes fibrous dysplasia- however this would not have a soft tissue component, or orbital lymphoma- but this would not cause this degree of bony hyperostosis.

I would inform the referring physician of the diagnosis and recommend discussion at neurosurgical MDT. An MRI study may be performed for further characterisation and surgical planning.