|Year : 1983 | Volume
| Issue : 4 | Page : 353-357
A-scan ultrasonography in orbital lesions
Brijesh Kumar Gupta, PK Agarwal, J Agarwal
Department of Ophthalmology. K.G's Medical College Lucknow, India
Brijesh Kumar Gupta
Department of Ophthalmology K.G's Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta BK, Agarwal P K, Agarwal J. A-scan ultrasonography in orbital lesions. Indian J Ophthalmol 1983;31:353-7
In the diagnosis of orbital lesions, ultrasonography has proved quite useful in localising the lesion as well as to find out its nature i.e. whether solid, cystic or vascular. It also helps in deciding the correct approach for the treatment of the proptosis whether medical or surgical.
Therefore, it will be in the fitness of the situation to report role of ultrasonography in 30 cases of unilateral proptosis who attended orbital Clinic of the Department of Ohthalmology, King George's Medical College, Lucknow from July 1981 to July 1982.
| Material and method|| |
Detailed history of patients was taken and clinical examination was carried out with the purpose of estabilishing the cause of proptosis. A-Scan ultrasonography was done in all these cases and its pattern was co-related with the clinical diagnosis to find out possible cause of proptosis as well as the site of the lesion. In those cases where surgery was indicated orbitotomy was done from the route as indicated by the ultrasonography. Finally, histological diagnosis was co-related with ultrasonographic and clinical diagnosis.
| Observations|| |
These 30 cases were divided into following groups on the basis of ultrasonographic patterns.
Thus one case who had trauma and haematoma of lid with mild proptosis was suspected as having retrobulbar haemorrhage but on ultrasonography, there was no haemorrhage in the orbit. In case of retinoblastoma, orbital extension of the tumor was detected with this procedure and therefore exenteration of the orbit was performed. Histology confirmed orbital extension and optic nerve infiltration.
If ultrasonography reveals unexplained infiltrating lesion of the orbit, possibility of secondaries is to be considered as was the case in metastatic adenocarcinoma.
| Solid mass lesions|| |
Solid mass lesions display a characteristic pattern on ultrasonography. There are deft, nite anterior and posterior boundary spikesrepresenting capsule of the mass while the intervening space is filled with irregular spikeof different heights depending on the type of lesions. This pattern was seen in cases suspec ted clinically as:
1. Parasitic Cyst 1 case
2. Orbital Tumours 9 cases
3. Inflammatory Granuloma 5 cases
4. Vascular Tumours 4 cases
5. Carotid Cavernous Fistula 1 case
This table shows that it is very difficult to find out the nature of orbital tumours by ultrasonograhy but it was quite useful in finding out the exact site of the tumour mass. In the case which was suspected as a parasitic cyst; it was diagnosed as a tumour at the apex of the orbit corresponded to the histological diagnosis of optic nerve glioma.
One case was diagnosed as pseudotumour on histology although ulrasonographic pattern was similar to true tumour. Thus, it is not possible to differentiate between pseudotumour and tumour ultrasonographically. In all these cases spikes were moderate to high amplitude.
In another case, spikes were high and width of spikes could be reduced on pressure, thus favouring haemangioma and histology also revealed the same.
| Discussion|| |
Orbit, known as magic box, poses a great problem for the diagnosis of lesions, responsible for proptosis. Ultrasonography has proved quite helpful in deciding the nature of lesions, its extent and the exact site of the orbital portion where the lesion may be present.
Out of 30 cases of unilateral proptosis included in this, study, in 2 cases ultrasonography failed to find out any lesion while in 1 case, pseudoproptosis due to high myopia was detected. 6 cases were infilterating whole of the orbit while in 21 cases, lesion was localised only in part of the orbit. When there is unexplained infilterating lesion, possbility of secondaries must be kept. In case of retinoblastoma, orbital extension was found out by ultrasonography. A case clinically considered as perasitic cyst was diagnosed as tumour on ultrasonography [Figure - 1][Figure - 2] and histology revealed optic nerve glioma. Lacrimal gland tumour exibit a characteristic tumour pattern when probe is applied from lower nasal quadrant and the spikes do not disappear even at 60 db. [Figure - 3][Figure - 4][Figure - 5]. Another case clinically considered as tumour exhibited high echospikes suggestive of haemangioma and after orbitotomy, histology was diagnosed as haemangioma.If repeat ultrasonograpy, after medical treatment, becomes normal, it is suggestive of inflammatory lesion; although in one case histology report was parasitic cyst which due to rupture produced inflammatory reaction and was thus confused with granuloma.
In 2 cases of haemangioma, orbital extension could only be diagnosed on ultrasonography [Figure - 6][Figure - 7]. A.V. fistula gives a characteristic pattern and similarly if two high spikes enclose a echo free space, it suggests a cystic lesion as in case of orbital abscess.
It finding out the site of tumour mass, ultrasonography is very helpful and in all the cases who underwent surgery (orbitotomy), the site of mass as detected by this procedure was very helpful in deciding the approach of orbitotomy (100%).
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]