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A case of misconstrue proptosis
Patrick J T Chiam1, Vivian W-M Ho, Alan D Hubbard
1Eye Care Centre, Leighton Hospital, Crewe, Cheshire, UK. pjtchiam@yahoo.com
BMJ Case Reports
|April 26, 2013
Summary
Metastatic lung carcinoma can present as orbital cellulitis, a rare but serious condition. Early diagnosis requires a high index of suspicion, as prompt treatment is crucial for managing this aggressive cancer.
Area of Science:
- Ophthalmology
- Oncology
- Radiology
Background:
- Metastatic lung carcinoma to the orbit is an uncommon presentation.
- Orbital metastasis can mimic infectious etiologies like cellulitis.
- Delayed diagnosis can lead to significant visual morbidity.
Observation:
- A patient presented with rapid onset of orbital edema and symptoms suggestive of cellulitis.
- Initial treatments with antibiotics were ineffective.
- Laboratory markers such as white blood cell count (WBC) and C-reactive protein (CRP) were within normal limits.
- Compressive optic neuropathy and serous retinal detachment developed.
Findings:
- An initial chest X-ray showed lung shadows but was not reviewed.
- A subsequent chest CT scan confirmed a primary lung mass.
- The orbital mass was confirmed as metastatic lung carcinoma.
Implications:
- This case highlights the importance of a high index of suspicion for orbital metastasis in patients with unexplained orbital symptoms.
- Early recognition and appropriate diagnostic workup, including advanced imaging, are critical for timely management.
- Despite multimodal treatment including chemotherapy and radiotherapy, visual prognosis can remain poor in advanced cases.
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