Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 22, 2014
Orbital Lipolysis
- The presence of disappearance of orbital fat and appearance of edema and enhancement has been described in the literature in markedly emaciated patients, such as those with anorexia nervosa. Our case was a patient with severe emaciation from cancer cachexia. It is reported that metabolic disturbances result in increased lipid peroxidation with subsequent increased permeability of vessel wall endothelium, explaining orbital edema and extravasation of contrast with diffuse enhancement on imaging. This finding is reversible.
- Key Diagnostic Features: Diffuse symmetric enhancement of orbital fat in patients who are severely emaciated. Other associated findings include subcutaneous fat wasting and marrow reconversion on MRI.
- DDx: Metastasis, especially from scirrhous breast carcinoma, which is also associated with enophthalmos
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