PMC7332550_01
(A) Clinical ophthalmic findings at the second ophthalmic examination. Findings include protrusion of the third eyelid, ventromedial strabismus, and episcleral hyperemia. (B) Clinical ophthalmic findings after 1 month of oral amoxicillin/clavulanic acid for pyogranulomatous myositis. The eye has returned to normal positioning, but positional ventral strabismus remains during dorsal extension of the neck (not pictured).
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F1
Three days later, the eye had ventromedial strabismus with a positive passive forced duction test, and anterior movement of the third eyelid was restricted when grasped with forceps (Figure 1).
(A) Transverse T2-weighted, (B) T2-FLAIR, (C) PD-weighted, (D) T2*-weighted GRE, (E) T1-weighted pre contrast, (F) T1-weighted post contrast and (G) T1-weighted Volume Interpolated GRE images with fat saturation ("VIBE") at the level of the frontal lobes. There is an ~2.5 x 1.3 x 1.2 cm (length x height x width) lesion located within the dorsal aspect of the left medial pterygoid muscle (box) which mostly follows the normal muscle contour aside from a focal region of muscle expansion in the dorsal aspect of the lesion. (A,B), The lesion is mildly heterogeneously T2 and FLAIR hyperintense, (C) mildly heterogeneously PD hyperintense, (D) heterogeneously T2* hyperintense, and (E) T1 iso-to mildly hyperintense. (F,G) The lesion is strongly and heterogeneously contrast enhancing.
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F2
One was associated with the left medial pterygoid muscle immediately ventral to the orbital fissure (Figure 2).
(A) Transverse T2-weighted, (B) T2-FLAIR, (C) PD-weighted, (D) T2*-weighted GRE, (E) T1-weighted pre contrast, (F) T1-weighted post contrast and (G) T1-weighted Volume Interpolated GRE images with fat saturation ("VIBE") at the level of the mandibular angle. There is an ~2.0 x 1.3 x 1.8 cm (L x H x W) ovoid lesion associated with the left side of the tongue base with imaging characteristics identical to the lesion associated with the left medial pterygoid muscle (arrows). (H) Transverse ultrasonographic image of the lesion at the tongue base which is hypointense, fairly homogeneous, and well-circumscribed (arrows). The impression of the lesion being right- rather than left-sided is artifactual and related to a change in tongue position between the MRI and ultrasound examination.
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F3
The second lesion was associated with the left side of the tongue base, was ovoid in shape, and measured ~2.0 x 1.3 x 1.8 cm (L x H x W) (Figures 3A-G). The tongue base lesion appeared well-circumscribed, hypoechoic, and fairly homogeneous (Figure 3H).