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A 30-year-old female presented with non axial proptosis of a left eye for the last 3 years. There is a history of trauma to the eye 10 years back. The imaging reveals a homogenous lesion in the left frontal sinus as given below. What is the diagnosis?
Frontal mucocele
Orbital pseudotumor
Correct Answer - A
Explanation
A mucocele is a mucus-filled cyst that can develop in the paranasal sinuses, typically arising due to obstruction of sinus ostia. Here's a breakdown of the options:
Frontal Mucocele (A):
• Relevant Findings: Mucoceles typically present as expansile, homogeneously enhancing lesions within a sinus. The slow expansion can cause remodeling of adjacent bones and, in the context of the frontal sinus, may cause proptosis if it extends into the orbit. A history of trauma can lead to the obstruction of the sinus drainage, resulting in a mucocele.
• Why it fits: The clinical presentation of proptosis, a history of trauma, and the imaging description of a homogenous lesion in the frontal sinus aligns with the characteristics of a frontal mucocele.
Frontal Meningioma (B):
• Relevant Findings: Meningiomas are tumors that arise from the meninges. While they can compress the orbit leading to proptosis, they would typically originate from the dura mater and not directly from within the sinus.
• Why it doesn't fit as well: While meningiomas can cause proptosis, the description of a lesion originating from the frontal sinus makes a meningioma less likely.
Orbital Pseudotumor (C):
• Relevant Findings: Orbital pseudotumor is an idiopathic inflammatory condition of the orbit. It would lead to pain, redness, and swelling of the affected eye.
• Why it doesn't fit: Given the history and presentation of a lesion within the frontal sinus, an orbital pseudotumor is not the best fit.
Juvenile Nasopharyngeal Angiofibroma (D):
• Relevant Findings: This is a benign but locally aggressive vascular tumor. It predominantly affects adolescent males and originates from the nasopharynx.
• Why it doesn't fit: The patient is a 30-year-old female, and the described lesion originates from the frontal sinus, not the nasopharynx.