| Identifier |
walsh_2014_s1_c3 |
| Title |
Renal Red Herring |
| Creator |
John J. Chen, John J. Brinkley, Namrata Singh, Amanda C. Maltry, Bruno A. Policeni, Richard C. Allen, Reid A. Longmuir, Matthew J. Thurtell |
| Subject |
Wegener's Granulomatosis; Renal Cell Carcinoma; Diplopia; Optic Neuropathy; Metastasis |
| History |
A 71 year-old Caucasian male with a history of Wegener's granulomatosis presented with vision loss OU and horizontal binocular diplopia. His past medical history was significant for Wegener's granulomatosis, which was diagnosed in 2000 on the basis of a renal biopsy. He was previously treated with various combinations of cyclophosphamide, azathioprine, and prednisone. His recent treatment regimen had included oral prednisone (7.5mg daily) and azathioprine (150mg daily). However, against medical advice, he had stopped taking his immunosuppressants for six months prior to his presentation in June 2013. His past history was also remarkable for Graves' disease, atrial fibrillation, hypertension, diabetes, and subdural hematoma in 2008 requiring surgical evacuation.At presentation, he reported a several week history of binocular horizontal diplopia on leftward gaze and concurrent progressive vision loss OS>OD. He also reported mild eye pain OS and occasional epistaxis. On examination, best-corrected visual acuity was 20/50 OD and 20/200 OS. Pupil examination demonstrated a 1.5 log unit RAPD OS without anisocoria. Intraocular pressures were normal. There was 3 mm of relative proptosis OS with a moderate abduction deficit OS. Anterior segment examination revealed cataract OU. Dilated funduscopic examination showed trace temporal optic disc pallor OS. Goldmann visual fields revealed central depression OD and a dense cecocentral scotoma OS. The RNFL thickness was within normal limits OU on optical coherence tomography. B-scan ultrasonography of the orbits revealed a highly-reflective mass superotemporally in the posterior orbit OS. MRI showed a well-circumscribed extraconal lateral orbital mass. CT demonstrated a soft tissue mass in the left orbital apex extending into the superior orbital fissure with associated erosion of the greater wing of the sphenoid, but without associated calcification.A diagnostic procedure was performed. |
| Disease/Diagnosis |
Renal cell carcinoma metastasis to the orbit. |
| Presenting Symptom |
A 71 year-old Caucasian male with a history of Wegener's granulomatosis presented with vision loss OU and horizontal binocular diplopia. |
| Neuroimaging |
Magnetic Resonance Imaging |
| Treatment |
Radiation Therapy |
| Date |
2014-03 |
| References |
None |
| Language |
eng |
| Format |
application/pdf |
| Type |
Image |
| Source |
46th Annual Frank Walsh Society Meeting |
| Relation is Part of |
Case presented at the NANOS 2014 Walsh Session, March 2 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6263 |
| Rights Management |
Copyright 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s60s2m13 |
| Setname |
ehsl_novel_fbw |
| ID |
179213 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s60s2m13 |
