MRI of the brain and orbits
Our imaging diagnostic work-up included some differential diagnoses. First, we considered a lymphoproliferative disorder, the most common primary orbital tumor in the elderly . However, it is mostly extraconal, it tends to mold orbital structures (globe, optic nerve, orbital wall) and it is usually hyperintense on T2 weighted images at MR imaging . Secondly, we hypothesized an orbital inflammatory pseudotumor, the third most common primary tumor of the orbit and a common cause of unilateral proptosis in adults ; however, it is commonly painful, while in our patient the lesion was indolent. Finally, we considered an orbital metastasis from previous breast cancer, although very unlikely considering the extreme rarity of orbital involvement by breast cancer metastasis and the fact that the patient’s breast cancer occurred many years before.
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