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Clinical Problem Solving
May 2014

An Infant With Right Eye Proptosis

Author Affiliations
  • 1Indiana University School of Medicine, Indianapolis

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JAMA Otolaryngol Head Neck Surg. 2014;140(5):471-472. doi:10.1001/jamaoto.2014.257

A previously healthy, full-term white male infant presented with concern for diplopia and a 2-month history of jerking right eye movements. Physical examination revealed mild right eye proptosis. Findings from anterior rhinoscopy were unremarkable. Magnetic resonance imaging (MRI) showed a 4.2 × 2.7 × 2.8-cm expansile osseous mass centered in the sphenoid sinus and right posterior ethmoid sinus, resulting in clinically significant narrowing of the right and left optic canals and orbital apices, right medial rectus deviation, and sellar compression. A representative, noncontrast, coronal T1-weighted MRI showed the lesion in the posterior ethmoid sinuses with displacement of the medial rectus and remodeling of the medial orbit (Figure, A). A contrast-enhanced computed tomographic (CT) scan showed the lesion to be well defined and lobulated. The matrix of the lesion was isodense to hyperdense as a result of psammomatoid ossicles, and small calcifications were later demonstrated through histological studies.

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