Orbital Rosai-Dorfman disease with subperiosteal bone involvement mimicking eosinophilic granuloma.

The presentation of RDD as an anterior subperiosteal orbital mass with bone involvement has, to the authors' knowledge, not been previously reported. We describe a case of Rosai-Dorfman disease (RDD) presenting as an anterior superolateral subperiosteal orbital mass with erosion of overlying bone mimicking eosinophilic granuloma. It was debulked using endoscopic-guided curettage and the patient was given both local and systemic corticosteroids. Careful histological analysis revealed the diagnosis of RDD and the patient remains asymptomatic and recurrence free at 16 months follow-up. Involvement of the pituitary gland, a recognized yet unusual finding in this condition was also noted. RDD should be considered in the differential diagnosis of a soft tissue mass of the superolateral orbit.

Prostatic adenocarcinoma presenting with metastatic frontal bone involvement and orbital invasion.

We present a rare case of prostatic adenocarcinoma presenting with metastatic frontal bone involvement with subsequent spread to the orbit. Although prostatic adenocarcinoma has a strong tendency to metastasize to bone, particularly axial skeletal bone, frontal bone involvement is rare and subsequent orbital involvement is even more so.

Paramuscular and paraneural perforators in DIEAP flaps: radiographic findings and clinical application.

The computed tomography microangiography revolutionized the planning of abdominal flaps, and enabled us to identify perforators from the deep inferior epigastric system with a medial extramuscular or minimal medial intramuscular trajectory. We define these perforators as paramuscular and paraneural, since their main course is retromuscular and they emerge medial to the medial border of rectus muscle or medial to its motor nerve supply, respectively. Studying the different perforator distributions in the abdomen of 58 patients who underwent breast reconstruction with deep inferior epigastric artery perforator flap, we have recorded that 46.4% of the abdominal walls have a dominant paramuscular/paraneural perforator (25.8% paramuscular and 20.6% paraneural) with an average diameter 1.56 +/- 0.2 mm. Although, the comparison of the rectus muscle morbidity following deep inferior epigastric artery perforator flap dissection based on paramuscular/paraneural and based on other perforator patterns, did not reveal significant differences, paraneural/paramuscular type perforators are not related anatomically to the motor nerves, and the donor site morbidity should be negligible in any operator's hands.

The Importance of Clinicians Reviewing CT Scans in Suspected Lacrimal Gland Disease Causing Eyelid Swelling, Even if Radiologists Previously Interpreted them as Normal.

PURPOSE: To highlight the importance of deliberate evaluation of the lacrimal gland during routine orbital imaging by both radiologists and clinicians, which may avoid delays in diagnosis of eyelid swelling related to lacrimal gland disease. METHODS: We present four cases referred to a tertiary ophthalmic plastic and orbital centre for assessment of chronic upper eyelid swelling of unknown aetiology. All four cases had been investigated with orbital CT imaging, reported to be normal by consultant radiologists. RESULTS: Careful review of existing imaging provided valuable information concerning the lacrimal gland and helped identify a pathological cause in all four cases. CONCLUSIONS: Lacrimal gland disease can be missed radiologically without evaluation of coronal as well as standard axial orbital imaging. Clear communication with the radiologist as well as personally reviewing scans can avoid such pitfalls.

Radiological pitfalls in patients with inducible dynamic proptosis.

We report two patients presenting with marked clinical unilateral enophthalmos who had positional variability and dynamic proptosis on valsalva. On orbital imaging, enophthalmos was not documented and in fact, globe proptosis of the same side was reported for one of the patients. During CT and MRI scanning patients are often instructed to hold their breath to eliminate motion artefact. This may inadvertently induce dynamic proptosis. The radiological pitfalls of imaging patients with inducible dynamic proptosis and how to identify such patients are discussed.

Scleral infiltration in orbitotemporal plexiform neurofibromatosis.

We report a case of severe orbitotemporal plexiform neurofibromatosis with a unique observation of clinically evident scleral infiltration, without uveal involvement, in a non-buphthalmic eye. We emphasize the importance of recognizing this before debulking surgery.