PMC6020486_01
Imaging studies. (a) Ultrasonographic images of the thyroid showing normal-sized gland with slightly enhanced blood flow. (b) 99mTc scintigraphy exhibiting an uptake within the normal range. (c) CT scan image showing enlarged inferior rectus muscle of the left eye. (d) Fat-suppression T2-weighted MRI image of the left eye showing inferior rectus muscle swelling with slightly high intensity signal of the muscle body.
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It showed normal-sized gland with slightly enhanced blood flow (Figure 1(a)). The result was again negative with 99mTc uptake of 0.50% for the right gland, 0.39% for the left gland, and total 0.89% (normal <5% in total) (Figure 1(b)). CT scan showed obvious enlargement of the inferior rectus muscle of the left eye (Figure 1(c)). MRI images of the orbit again showed inferior rectus muscle swelling of the left eye (Figure 1(d)). Fat-suppression T2-weighted images showed a slight increase in the MR intensity of the muscle involved (Figure 1(d)), suggesting active inflammation of the extraocular muscle. No tumorous lesion was detected within the orbital cavity (Figures 1(c) and 1(d)).
Clinical course of the patient. The patient was hospitalized and received intravenous and oral corticosteroid therapy in conjunction with orbital radiotherapy. Intravenous methylprednisolone 1000mg/day for 3 days followed by oral prednisolone 30mg/day for 4 days were defined as one cycle, and he received 3 cycles consecutively with a slightly decreased methylprednisolone i.v. in the third cycle. Orbital radiation therapy was commenced on day 2 and 2Gy/day radiation was continued for 10 days (20Gy total). The patient was discharged on oral corticosteroid therapy with decreasing doses.
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Under the diagnosis, he was hospitalized and treated with the combination of corticosteroid pulse therapy and radiation therapy of the orbit (Figure 2). Although the swelling of the left eyelid disappeared on day 3 (Figure 2), proptosis, abnormality in ocular movement, and diplopia were all unchanged until discharge. Examination by the exophthalmometer revealed the remaining of the exophthalmoses of 16mm on the right and 18mm on the left when he left hospital on day 18 (Figure 2).