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Clinical Problem Solving: Radiology
August 16, 2010

Radiology Quiz Case 1

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(8):836. doi:10.1001/archoto.2010.125-a

A 46-year-old man presented with a 1-month history of left-sided painless periorbital progressive swelling, a drooping left eyelid, and binocular diplopia. His visual acuity was 20/20 in both eyes. He also had periorbital edema in his left eye, a 2-mm left-sided axial proptosis, and left-sided hypertropia, with restriction in ocular motility in the inferior direction (Figure 1). Transnasal endoscopy showed a grayish white polypoid mass filling the left sinonasal cavity (Figure 2). Computed tomography without enhancement revealed a soft-tissue mass filling the left nasal cavity and the maxillary and ethmoid sinuses. The left medial and inferior rectus muscles were involved, and the globe was displaced superiorly. There was evidence of deossification and bony erosion of the medial orbital wall (Figure 3, arrow), left cribriform plate, and lateral lamella (Figure 3, arrowhead).

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