Lymphocytic orbital tumor of unknown origin.
Symptoms and findings: Painful, moderately severe inflammatory reaction with eyelid swelling, chemosis, and unilateral or bilateral exophthalmos.
Involvement of the ocular muscles results in limited motility with diplopia.
Diagnostic considerations: The CT and MR images will show diffuse soft-tissue swelling. A biopsy is required to confirm the diagnosis.
Occasionally the CT image will simulate an infiltrative tumor.
Differential diagnosis: Various disorders should be excluded. These include Graves' disease and orbital cellulitis, which is usually bacterial. Special forms of orbital pseudotumor include myositis and Tolosa-Hunt syndrome (painful total ophthalmoplegia produced by an idiopathic granuloma at the apex of the orbit).
Treatment: High-dose systemic cortisone (initially 100 mg of prednisone) usually leads to remission. Orbital radiation therapy or surgical intervention may be indicated in cases that fail to respond to treatment.
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