journal name: journal of case reports and images in ... · 6 parag h mehta 1, siddharth r bhesania...

Manuscript Accepted Early View Article

of 7

Early View Article: Online published version of an accepted article before publication in the

final form.

Journal Name: Journal of Case Reports and Images in Medicine

Type of Article: Clinical Images

Title: Clinical dilemma of unilateral popping eye

Authors: Parag H Mehta, Siddharth R Bhesania, Hojoon you

doi: To be assigned

Early view version published: December 13, 2016

How to cite the article: Mehta PH, Bhesania SR, You H. Clinical dilemma of unilateral

popping eye. Journal of Case Reports and Images in Medicine. Forthcoming 2016.

Disclaimer: This manuscript has been accepted for publication. This is a pdf file of the

Early View Article. The Early View Article is an online published version of an accepted

article before publication in the final form. The proof of this manuscript will be sent to the

authors for corrections after which this manuscript will undergo content check,

copyediting/proofreading and content formatting to conform to journal’s requirements.

Please note that during the above publication processes errors in content or presentation

may be discovered which will be rectified during manuscript processing. These errors may

affect the contents of this manuscript and final published version of this manuscript may

be extensively different in content and layout than this Early View Article.


of 7

TYPE OF ARTICLE: Clinical Images 1

2

TITLE: Clinical dilemma of unilateral popping eye 3

4

AUTHORS: 5

Parag H Mehta1, Siddharth R Bhesania2, Hojoon you3 6

7

AFFILIATIONS: 8

1MD, senior vice chairman, Dept of Medicine, New York Methodist Hospital, NY 9

USA; email: [email protected] 10

2MD, MPH, IT data coordinator, Dept of Medicine, New York Methodist Hospital, NY 11

USA; email: [email protected] 12

3MD, Resident PGY3, Dept of Medicine, New York Methodist Hospital, NY USA; 13

email: [email protected]; 14

15

CORESPONDING AUTHOR DETAILS 16

Siddharth Ravinbhai Bhesania, MD, MPH 17

NY Methodist Hospital, 506 6th Street Brooklyn, NY 11215 18

Email: [email protected] 19

20

Short Running Title: Clinical Dilemma of Popping Eye 21

22

Guarantor of Submission : The corresponding author is the guarantor of 23

submission. 24

25

26

27

28

29

30

31

32


of 7

TITLE: Clinical dilemma of unilateral popping eye 33

34

CASE REPORT 35

36 year old male presented in emergency department with worsening left eye 36

protrusion since 2 and ½ years [Figure 1]. He also complained of left eye dull pain 37

(3/10) and headaches for 2 weeks without any visual changes. No symptoms 38

suggestive of thyroid disease. He had no significant past medical history. His Visual 39

field and rest of the physical examination was normal. Patient's BP was elevated 40

(171/112 mmHg) in the ED but came down to normal eventually. On CT scan of the 41

head [Figure 2a], he had a large soft tissue homogenous mass extending into the left 42

orbit measuring 5 x 3.8cm in axial dimension. Patient had endoscopic sinus surgery 43

and resection of the left ethmoid mucocele and orbital decompression that he 44

tolerated well with improvement of his proptosis [Figure 2b]. Post operatively patient 45

complained of diplopia, which resolved eventually. 46

47

DISCUSSION 48

Para-nasal sinus mucocele is described as slowly expanding benign cystic lesion. 49

Frontal and ethmoidal sinuses are being the most commonly affected with the 50

condition. Most of the time it is filled with mucus and respiratory epithelium. The 51

exact mechanism causing mucocele is unclear however obstruction of ostia due to 52

inflammation, fibrosis, trauma, anatomical anomaly or polyps may be the cause [1, 53

2]. It may occur at any time but most commonly prevalent in 30 to 70 years of age 54

irrespective of gender. If left untreated gradually it expands and may push 55

surrounding structures especially bony walls of affected sinus, occasionally affecting 56

orbit and intracranial cavity. Usually when it is small it is asymptomatic. As it expands 57

it can cause headaches, facial asymmetry, orbital pain, and vision problem 58

depending on the site of expansion. In our case the cause for mucocele was unclear 59

and patient had headaches with left eye pain without any vision problem. When 60

mucocele expands in orbital cavity pushing the structures behind the eyeball it can 61

cause proptosis. There can also be visual acuity problem if the optic nerve is 62

compressed. 63


of 7

CT scan is the confirmatory diagnostic test showing low density, soft tissue 64

homogenous mass. MRI can be useful to differentiate the cause especially if it is 65

neoplasm. If mucocele is infected it can rapidly expand and compress surrounding 66

structures. Culture of the aspiration can confirm infection [3]. 67

Treatment always consists of surgery, which can be external approach or 68

endoscopic depending upon size and location of mucocele. In recent years 69

endoscopic approach has been widely used due to its advantage of minimal damage 70

to mucosa and maintenance of a patent sphenoethmoidal recess [4]. 71

72

CONCLUSION 73

• Most common cause of proptosis : Thyroid disease -History is important to 74

identify other causes 75

• Mucocele is relatively rare to develop up to this stage where it gives proptosis. 76

The situation could have been prevented if there was early intervention. 77

78

Key words: Popping eye, unilateral proptosis, mucocele, diplopia 79

80

CONFLICT OF INTEREST 81

The authors certify that they have NO affiliations with or involvement in any 82

organization or entity with any financial interest (such as honoraria; educational 83

grants; participation in speakers’ bureaus; membership, employment, consultancies, 84

stock ownership, or other equity interest; and expert testimony or patent-licensing 85

arrangements), or non-financial interest (such as personal or professional 86

relationships, affiliations, knowledge or beliefs) in the subject matter or materials 87

discussed in this manuscript. 88

89

AUTHOR’S CONTRIBUTIONS 90

Parag H Mehta, MD 91

Group1 - Conception and design, 92

Group 2 -Critical revision of the article 93

Group 3 - Final approval of the version to be published 94

95


of 7

Siddharth R Bhesania, MD, MPH 96

Group1 - Acquisition of data/images, interpretation images 97

Group 2 - Drafting the article, 98


100

Hojoon you, MD 101

Group1 - Conception and design, interpretation images 102

Group 2 - Drafting the article, Critical revision of the article 103


105

REFERENCES 106

1. Manaka H, Tokoro K, Sakata K, et al. Intradural extension of mucocele 107

complicating frontoethmoid sinus osteoma: case report. Surg Neurol 1998; 50: 108

453–456. 109

2. Nakajima Y, Yoshimine T, Ogawa M, et al. A giant intracranial mucocele 110

associated with an orbitoethmoidal osteoma. Case report. J Neurosurg 2000; 111

92: 697–701. 112

3. Brook I, Frazier EH. The microbiology of mucopyocele. Laryngoscope 2001; 113

111: 1771-3. 114

4. Kuhn FA, Javer AR. Primary endoscopic management of the frontal sinus. 115

Otolaryngol Clin North Am 2001; 34:59-75. 116

117

Suggested Reading: 118

1. Paranasal sinus mucocele : https://radiopaedia.org/articles/paranasal-sinus-119

mucocoele 120

2. Erini M, Nouredine G. Exophthalmos caused by an ethmoidal mucocele. 121

http://appliedradiology.com/articles/exophthalmos-caused-by-an-ethmoidal-122

mucocele 123

3. Canalis R; Zajtchuk J; Jenkins H. Ethmoidal Mucoceles. 124

http://jamanetwork.com/journals/jamaotolaryngology/article-abstract/607246 125

126

127


of 7

ABBREVIATIONS 128

129

BP = blood pressure, ED = Emergency Department 130

131

FIGURE LEGENDS 132

133

Figure 1: Patient Photo showing popping of left eye. 134

135

Figure 2: (A) - Pre-Surgery CT scan of head: showing large mucocele evading left 136

eye socket pushing eye ball out (B) - Post-Surgery CT scan of head: showing 137

mucocele removed via endoscopic sinus surgery 138

139

FIGURES 140

141

142

143

Figure 1: Patient Photo showing popping of left eye. 144


of 7

145

146

Figure 2: (A) - Pre-Surgery CT scan of head: showing large mucocele evading left 147

eye socket pushing eye ball out (B) - Post-Surgery CT scan of head: showing 148

mucocele removed via endoscopic sinus surgery 149

journal name: journal of case reports and images in ... · 6 parag h mehta 1, siddharth r bhesania...

Documents