R. NICKBRYANMDPATRICIA A.HUDGINSMD
A 58-year-old woman with type 2 diabetes mellitus presented with a 1-week history of swelling of her left eye. She also had a fever, headache, diplopia, and decreasing visual acuity in her left eye. Physical examination revealed periorbital swelling of the left eye, chemosis, and palsy of cranial nerves III, IV, and VI. Ophthalmoscopy showed decreased vascularity of the central retinal artery. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed.
Contrast-enhanced CT demonstrated opacification of the ethmoid and sphenoid sinuses (Figure 1, asterisk), destruction of the left sphenoid sinus wall (Figure 1, arrow), and heterogeneous enhancement of the periorbital tissue of the left eye (Figure 1, arrowhead). An enlarged left cavernous sinus with a filling defect and a hypodense lesion with ring-enhancement in the left temporal lobe were observed on contrast-enhanced T1-weighted MRI (Figure 2, arrow). A biopsy of the left sphenoid sinus lesion was performed endoscopically, and the histologic features are shown in Figure 3 (hematoxylin-eosin) and Figure 4 (methenamine silver).
Huang S, Chiou S. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2005;131(8):738. doi:10.1001/archotol.131.8.738