Case 6

I am presented with a CT brain study; the salient abnormality is masses and nodules of varying size within both orbits in the orbital fat. These are of relatively dense soft tissue density, and are seen in both the intra-conal and extra-conal space. I note that they do not involve the lacrimal glands.

The top differential for these lesions is deposits of haematological malignancies, such as lymphoma or leukemia.

Other differentials include metastatic disease from a distant primary, IgG4 related ophthalmic disease, and multiple cavernous malformations.

I would review any prior imaging if available, and ask the referring physician if the patient has been diagnosed with any malignancy.

I would recommend an MRI study of the orbits with contrast administration as further investigation, and raise this case for discussion at the relevant MDT.