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Right Proptosis, Diplopia
This case features a patient presenting with right proptosis and diplopia, ultimately diagnosed with a post-traumatic orbital mucocele.
Imaging overview:
Coronal T2 fat-saturated, coronal T1, and coronal T1 fat-saturated post-contrast MRI of the orbits demonstrate a T2 hyperintense, T1 intermediate dome-shaped cystic structure in the right orbit with only thin peripheral enhancement. Ripples of susceptibility artifact from a prior orbital floor reconstruction with titanium plate are also identified, consistent with the history of remote orbital trauma.
Clinical insight:
Post-traumatic orbital mucoceles are an uncommon but important late complication of orbital blowout or blow-in fractures, presenting with proptosis and diplopia years to decades after the initial injury. On MRI, the lesion characteristically demonstrates thin peripheral enhancement reflecting the underlying cuboidal ciliated epithelium, with a central mucous-containing cyst whose T1 and T2 signal intensity varies depending on protein content and degree of desiccation. Recognizing the prior surgical history and characteristic MRI signal pattern is key to distinguishing this entity from other orbital cystic lesions and avoiding unnecessary aggressive intervention.
Case courtesy of Daniel Warren, MD
University of Illinois – Carle College of Medicine