Table 1 Diffrential diagnosis
From: A case of bilateral amyloidosis localized to extraocular muscles mimicking thyroid eye disease
Differential diagnosis | Symptoms | Steroid reactive | CT finding | MRI findings |
|---|---|---|---|---|
Amyloidosis | Diplopia, ophthalmoplegia, proptosis | - | Fusiform muscle enlargement, calcification, adjacent hyperostosis, bony irregularity | Fusiform muscle enlargement, heterogenous compositiom, T1and T2: not specified signal intensity |
Thyroid eye disease | Diplopia, ophthalmoplegia, proptosis, eyelid retraction, lid lag, red eye, optic neuropathy, lid swelling, and/or periorbital swelling | + | Fusiform muscle enlargement, tendinous insertion is less commonly involved | Fusiform muscle enlargement with sharp borders, T1: isointense to the other facial muscles, or fatty infiltration, T2: high, STIR: high signal intensity |
Metastatic tumor | Ophthalmoplegia, proptosis, with or without diplopia | - | Variable, soft tissue attenuating material | T1: isointense to muscle, T2: hyperintense to muscle, hypointense to fat |
IgG4 related disease | Lacrimal gland involvement, painless, periorbital and/or lid swelling, erythema, proptosis, with or without diplopia | + | Enlargement of the lacrimal gland and/or extraocular muscle(s) | T1: isointence to muscle, T2: hyperintence to muscle |
Carotid cavernous fistulae | Conjunctival injection, pulsatile proptosis, diplopia | - | Dilation of the superior ophthalmic vein | dilation of the supreior ophthalmic vein |
Idiopathic orbital inflammation | Periorbital edema, swelling, ophthalmoplegia, rapid-onset, usually unilateral, painful proptosis and diplopia | + | Enlargement of the muscle belly typically with the involvement of tendinous insertions | T1: typically isointence or hypointence, T2: typically hypointense |