case_images: PMC10769501_01
case_images: Clinical presentation. External photograph showing subtle right-sided periocular edema. Hertel exophthalmometer measurements were 19 mm OD and 13 mm OS with a base of 97 mm.
case_images: cop-2024-0015-0001-534926_F01.jpg
case_images: PMC10769501_01_cop-2024-0015-0001-534926_F01.jpg
case_images: F1
case_images: Pertinent positive findings included right-sided mild periocular edema, right eyelid tenderness, decreased right palpebral fissure height, and proptosis (Fig. 1).
case_images: Pseudocolor images of the right (a) and left (b) eye. There is slight nasal elevation of the right compared to left optic disc margin.
case_images: cop-2024-0015-0001-534926_F02.jpg
case_images: PMC10769501_01_cop-2024-0015-0001-534926_F02.jpg
case_images: F2
case_images: His posterior segment showed mild nasal elevation of the right optic disc without vessel obscuration and mild tortuosity of the peripheral vessels (Fig. 2).
case_images: MRI of head and spine before and after chemotherapy induction with Children's Oncology Group protocol AALL1732 for high-risk pre B-ALL. Red arrows indicate mass. a Initial T2 sequence coronal view showing large soft tissue mass centered in the right infratemporal fossa with intracranial, extracranial, subtemporal, and extraconal extension. Right optic nerve and right lateral rectus muscle displacement medially with proptosis. b Red arrows indicate mass. T2 sequence coronal view of soft tissue mass with interval improvement of soft tissue mass centered in the right infratemporal fossa with intracranial, extracranial, subtemporal, and extraconal extension.
case_images: cop-2024-0015-0001-534926_F03.jpg
case_images: PMC10769501_01_cop-2024-0015-0001-534926_F03.jpg
case_images: F3
case_images: The patient then underwent an MRI of the head and spine with contrast which showed a right-sided soft tissue mass (5.4 x 6.8 x 7.0 cm) centered on the sphenoid bone with extension into the right orbit (Fig. 3a). Repeat MRI head following induction showed a marked interval decrease in size of the sphenoidal mass and complete resolution of the intracranial and intra-axial extension (Fig. 3b).