CT images through the orbits (top) demonstrate proptosis on the right, haziness
of the intraconal and extraconal fat extending to the orbital apex, and enlargement
of the medial rectus. Abnormal soft tissue (bottom left image) is also demonstrated
within the retromaxillary fat, and changes in the superficial soft tissues of the
face are noted. Opacification of the paranasal sinuses is evident. Coronal images
through the sella (bottom right) reveal no enhancement of the right cavernous sinus.
Proptosis, edema within the intraconal fat and medial rectus are confirmed on the
axial T2 MR image (top left). Swelling of the overlying soft tissues is evident.
MR angiogram (top right) demonstrates patent carotid arteries bilaterally. Bottom
right images through the cavernous sinuses show deficient enhancement in the right
cavernous sinus, suggesting thrombosis.
FLAIR (left images) and diffusion (center) demonstrate abnormality in the medial
temporal and occipital lobes, with involvement of the right pons, thalamus, internal
capsule and globus pallidus, consistent with infarct. Moderate amount of mass effect
is present. Also note the abnormal tissue in the right prepontine cistern.
The patient is status post right orbital exenteration with a right anterior and
posterior ethmoidectomy and right sphenoidotomy. Source and MIP images of an MR
angiogram (right) reveal apparent occlusion of the right cavernous internal carotid
artery. No signal is seen in the right posterior cerebral artery beyond the P1
segment consistent with occlusion.
Key words: ct mr mri infection inflammation orbit paranasal sinuses
ENT & Brain Diagnosis:
1. Rhinocerebral mucormycosis
2. Cavernous sinus thrombosis
3. Right carotid occlusion
4. Cerebral infarct