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2009 Series : October 6, 2009

December 29, 2009  |  December 22, 2009  |  December 15, 2009  |  December 8, 2009  |  December 1, 2009  |  November 24, 2009  |  November 17, 2009  |  November 10, 2009  |  November 3, 2009  |  October 27, 2009  |  October 20, 2009  |  October 13, 2009  |  October 6, 2009  |  September 29, 2009  |  September 22, 2009  |  September 15, 2009  |  September 8, 2009  |  September 1, 2009  |  August 25, 2009  |  August 18, 2009  |  August 11, 2009  |  August 4, 2009  |  July 28, 2009  |  July 21, 2009  |  July 14, 2009  |  July 7, 2009  |  June 30, 2009  |  June 23, 2009  |  June 16, 2009  |  June 9, 2009  |  June 2, 2009  |  May 26, 2009  |  May 19, 2009  |  May 12, 2009  |  May 5, 2009  |  April 28, 2009  |  April 21, 2009  |  April 14, 2009  |  April 7, 2009  |  March 31, 2009  |  March 24, 2009  |  March 17, 2009  |  March 10, 2009  |  March 3, 2009  |  February 24, 2009  |  February 17, 2009  |  February 10, 2009  |  February 3, 2009  |  January 27, 2009  |  January 20, 2009  |  January 13, 2009  |  January 6, 2009

To see views enlarged, click on the individual pictures...

QOW100609_1A QOW100609_1B

 

QOW100609_1C

A 71-year-old man presented to the emergency room (ER) with an acute, less than 24-hour, history of right periorbital edema, chemosis, and mild pain. His past medical history was significant for recurrent chronic myelogenous leukemia being treated with systemic chemotherapy. He recently had chemotherapy-related gastrointestinal bleeding for which he was given aminocaproic acid, which he was still taking at the time of presentation. One week prior the patient had a chemotherapy-induced acute increase in his platelet count from 9,000 to 618,000. A brain MRI ordered the day prior for headache was negative. In the ER, the patient was afebrile, and his white blood cell count was 34,000 with 10% blasts, a finding thought to be secondary to his leukemia. The patient denied history of trauma, infection, thyroid abnormality, or auditory bruit. On exam he was mildly somnolent. His visual acuity from the right eye was 20/200, and 20/25 from the left. He had a relative afferent pupillary defect on the right. His intraocular pressure was 35mmHg in the right eye. Ocular adnexal exam confirmed periorbital edema, chemosis, resistance to retropulsion, and ophthalmoplegia. There was no tenderness or warmth, and V1 and V2 sensory innervation were intact. Retinal exam was within normal limits. Orbital CT with contrast was obtained.

1. The differential diagnosis includes all of the following, except:

a. orbital cellulitis
b. venous thrombosis (superior ophthalmic vein or cavernous sinus)
c. thyroid eye disease
d. idiopathic orbital inflammation
e. pleomorphic adenoma of the lacrimal gland

2. The CT findings are consistent with which diagnosis?

a. superior ophthalmic vein thrombosis
b. orbital abscess
c. thyroid eye disease
d. idiopathic orbital inflammation
e. optic nerve sheath meningioma

3. Likely etiologies for this patient's presentation include:
a. hyperthyroidism
b. ethmoidal sinusitis
c. history of cancer, aminocaproic acid, and thrombocytosis
d. trauma
e. sarcoidosis

For answers to the above, click here on or after October 13, 2009.

 

 

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