Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement

Giovanni H. Greaves, Kym Livingston, Grant T. Liu, Kenneth S. Shindler, Nicholas J Volpe, Maxwell Pistilli, Sonul Mehta, Madhura A. Tamhankar

Research output: Contribution to journalArticle

Abstract

Neoplastic infiltration of the extraocular muscle (EOM) is a rare condition which can pose a diagnostic dilemma due to its rarity and overlapping ultrasonographic features with orbital myositis. The ultrasonographic features of neoplastic enlargement of EOM have not been systematically studied and previously have been described in only a few case reports. Orbital ultrasonography, in conjunction with the pattern of ocular misalignment, was assessed for its potential role in identifying patients with neoplastic EOM enlargement. Retrospective chart review of patients with neoplasm and myositis. The clinical features of 8 patients with neoplastic infiltration of the EOM were compared to 15 patients with myositis. In the neoplastic group the width of the EOM was (10.5 mm) almost twice the normal width of the muscle with myositis (p < 0.001). All the muscles in the neoplastic category were low to medium reflective. Paretic deviation was seen in 4/8(50%), purely restrictive in 2/8 (25%) and combined pattern in 2/8 (25%) were noted. In the myositis group the average EOM enlargement was 5.8 mm and all muscles showed low reflectivity. Although ultrasonographic features overlapped between the 2 groups paretic deviations were more common in the neoplastic group versus the myositis group (50% versus 7%). Neoplastic muscle enlargement tends to be larger with paretic deviations of ocular motility seen clinically. These findings in a patient with EOM enlargement should raise the suspicion of neoplasm as the etiology and further work up should be considered.

Original languageEnglish (US)
Pages (from-to)317-321
Number of pages5
JournalOrbit
Volume36
Issue number5
DOIs
StatePublished - Sep 3 2017

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Oculomotor Muscles
Myositis
Ultrasonography
Muscles
Orbital Myositis
Neoplasms

Keywords

  • extraocular
  • muscles
  • Tumors
  • ultrasonography

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Greaves, G. H., Livingston, K., Liu, G. T., Shindler, K. S., Volpe, N. J., Pistilli, M., ... Tamhankar, M. A. (2017). Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement. Orbit, 36(5), 317-321. https://doi.org/10.1080/01676830.2017.1337173
Greaves, Giovanni H. ; Livingston, Kym ; Liu, Grant T. ; Shindler, Kenneth S. ; Volpe, Nicholas J ; Pistilli, Maxwell ; Mehta, Sonul ; Tamhankar, Madhura A. / Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement. In: Orbit. 2017 ; Vol. 36, No. 5. pp. 317-321.
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abstract = "Neoplastic infiltration of the extraocular muscle (EOM) is a rare condition which can pose a diagnostic dilemma due to its rarity and overlapping ultrasonographic features with orbital myositis. The ultrasonographic features of neoplastic enlargement of EOM have not been systematically studied and previously have been described in only a few case reports. Orbital ultrasonography, in conjunction with the pattern of ocular misalignment, was assessed for its potential role in identifying patients with neoplastic EOM enlargement. Retrospective chart review of patients with neoplasm and myositis. The clinical features of 8 patients with neoplastic infiltration of the EOM were compared to 15 patients with myositis. In the neoplastic group the width of the EOM was (10.5 mm) almost twice the normal width of the muscle with myositis (p < 0.001). All the muscles in the neoplastic category were low to medium reflective. Paretic deviation was seen in 4/8(50{\%}), purely restrictive in 2/8 (25{\%}) and combined pattern in 2/8 (25{\%}) were noted. In the myositis group the average EOM enlargement was 5.8 mm and all muscles showed low reflectivity. Although ultrasonographic features overlapped between the 2 groups paretic deviations were more common in the neoplastic group versus the myositis group (50{\%} versus 7{\%}). Neoplastic muscle enlargement tends to be larger with paretic deviations of ocular motility seen clinically. These findings in a patient with EOM enlargement should raise the suspicion of neoplasm as the etiology and further work up should be considered.",
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Greaves, GH, Livingston, K, Liu, GT, Shindler, KS, Volpe, NJ, Pistilli, M, Mehta, S & Tamhankar, MA 2017, 'Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement' Orbit, vol. 36, no. 5, pp. 317-321. https://doi.org/10.1080/01676830.2017.1337173

Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement. / Greaves, Giovanni H.; Livingston, Kym; Liu, Grant T.; Shindler, Kenneth S.; Volpe, Nicholas J; Pistilli, Maxwell; Mehta, Sonul; Tamhankar, Madhura A.

In: Orbit, Vol. 36, No. 5, 03.09.2017, p. 317-321.

Research output: Contribution to journalArticle

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T1 - Orbital ultrasonography in the diagnosis of neoplastic extraocular muscle enlargement

AU - Greaves, Giovanni H.

AU - Livingston, Kym

AU - Liu, Grant T.

AU - Shindler, Kenneth S.

AU - Volpe, Nicholas J

AU - Pistilli, Maxwell

AU - Mehta, Sonul

AU - Tamhankar, Madhura A.

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