PMC6346776_01
MRI brain images showing progression of orbital apex involvement. (A) The initial scan on 29 August 2016 before the onset of neurological symptoms reveals only minor mucosal thickening (arrow) in the left sphenoid sinus. (B) MRI of the brain on 16 September 2016 shortly after the onset of diplopia shows worsening of posterior ethmoid and sphenoid sinusitis, with slight prominent enhancement in the left orbital apex, which can be better appreciated on its T1W image (C).. (D) MRI of the orbit on 22 September 2016 demonstrates inflammatory soft tissue (orange arrow) extending beyond the left orbital apex into the retro-orbital region, with enhancement (blue arrow) of the rectus muscles and optic nerve
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The images incidentally demonstrated mucosal thickening in the left posterior ethmoid and left sphenoid sinuses with retention cysts (Fig. 1B). Magnetic resonance thin-slice imaging of the orbit was performed, demonstrating the presence of soft tissue in the left sphenoid sinus extending towards the left orbital apex and anterior left cavernous sinus (Fig. 1D).
Green arrow indicating bony erosion of the left lateral wall of the sphenoid sinus.
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