PMC4446461_01
Photographic image of the patient showing the left periorbital swelling.
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An ophthalmological examination showed the fullness over the left upper lid and mild ptosis (Figure 1).
Selected fundoscopy images of the retina (a) at the level of the left optic nerve (Op) and (b) at the level of the right optic nerve (Op); (c) left nasal equatorial retina; (d) ultrasound B-scan with vector A scan. Images (a) and (c) show multiple ill-defined tumors with irregular surface (marked with white arrows in images (a) and (c)). Image (b) shows the comparative normal appearances of the right side. Image (d) shows the retinal lesion (T) with high intralesional reflectivity (white arrowheads).   is artifact.
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There was no evidence for choroidal excavation (Figure 2).
Axial susceptibility-weighted MRI image (TR-50; TE-40) showing multiple "dark" spots of magnetic susceptibility seen scattered in both cerebral hemispheres consistent with hemorrhagic brain metastasis.
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fig3
Magnetic resonance imaging (MRI) scan of the brain revealed multiple small hemorrhagic metastases demonstrated on susceptibility-weighted imaging (SWI) (Figure 3).
Axial T1-weighted image MRI (a) showing hyperintense lesion in the retinal choroid with a mild exophytic thickening of the uvea. Axial noncontrast enhanced CT section (b) in bone window projection showing the lesion to be of soft tissue densities without calcification.
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T1-weighted images (Figure 4).
Axial T2-FLAIR MRI image showing that the lesion appears hypointense to gray matter with typical signal intensities of the optic nerve.
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The lesion was hypointense on T2-FLAIR images (Figure 5). The high-resolution axial 3D- constructive interference in steady state (CISS) images showed the full extent of the lesion, which was confined to the retinal choroid with normal appearances of the vitreous chamber of the globe (Figure 6).
Axial CISS (constructive interference in steady state) MRI images showing that theretinal choroidal lesion shows similar signal characteristics as on T2-weighted images. No calcific signal foci are seen within the lesion. The CISS images provide high spatial resolution and help in radiologically defining the extent of the tumor.
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fig6
The lesion was hypointense on T2-FLAIR images (Figure 5). The high-resolution axial 3D- constructive interference in steady state (CISS) images showed the full extent of the lesion, which was confined to the retinal choroid with normal appearances of the vitreous chamber of the globe (Figure 6).
Contrast-enhanced axial (a) and sagittal T1-weighted MRI image showing the choroidal retinal mass and the peripherally enhancing lobulated lesion in the superior lateral extraconal plane centered in the region of the left lacrimal gland.
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Another focal lesion was seen centered in the left lacrimal gland distorting the lacrimal contour (Figure 7).
Axial noncontrast enhanced CT section in bone window projection (a) showing periosteal reaction exerted by the lesion on the superior orbital ridge seen as amorphous density. Contrast-enhanced sagittal T1-weighted MRI image (b) showing an amorphous area of enhancement of the lesion.
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fig8
The dark periosteum of the superior orbital ridge was lost in the MRI study, which showed an amorphous enhancement, and a comparison with the CT study revealed faint periosteum thickening (Figure 8).