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CT Optic Nerve Sheath Meningioma

Case Study

Case Study

CT Optic Nerve Sheath Meningioma

History of sudden seizure after being outside most of the day. Vomited on the way to the emergency clinic. No history of previous health problems. Toxin access unlikely. Exophthalmos OS for about 1 year. Not on any medications. PE WNL.  Temp 102.1, pulse 150, respiration panting

 

History of sudden seizure after being outside most of the day. Vomited on the way to the emergency clinic. No history of previous health problems. Toxin access unlikely. Exophthalmos OS for about 1 year. Not on any medications. PE WNL.  Temp 102.1, pulse 150, respiration panting

 

DX

Retrobulbar soft tissue neoplasm, moderately aggressive with potential origin from the optic nerve/optic nerve sheath. R/O optic nerve sheath meningioma, possibly but less likely (because of CT morphology and relatively "benign" features of the mass lesion) mesenchymal and epithelial soft tissue neoplasm. Reactive lymph node hyperplasia.

Image Interpretation

Post contrast series:
There was an ovoid space-occupying lesion measuring 2 x 2.5 x 2.5 cm within the retrobulbar space of the left orbita displacing the globe rostromedially. The lesion showed moderate, non-uniform contrast enhancement with one central necrotic non-enhancing area. The lesion appeared to be centered around the optic nerve. The ipsilateral optic canal was mildly enlarged. The vessels within the optic canal were mildly displaced ventrolaterally by the potentially swollen optic nerve. The globe was macroscopically not infiltrated. There was mild pressure atrophy of the adjacent frontal bone. No aggressive bony lysis was seen. The left medial retropharyngeal lymph node was moderately enlarged in size with preserved short to long axis ratio and enhancement pattern.

Outcome

For further work-up fine needle aspiration or biopsy is recommended. This should preferentially be done under ultrasound guidance. The affected globe should be tested for maintenance of vision and IOP changes.

Video

Video Player

Patient Information

Patient Name : Buddy Bailor, Animal Emergency Center
Type of Imaging : Ultrasound
Status : Complete

Images

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Blood Chemistry

  • ALT (SGPT), High

Urinalysi

  • pH High