case_images: PMC11745171_01
case_images: Position of both eyes in different gaze noted after blunt trauma in a child with para-meningeal rhabdomyosarcoma. In primary gaze, there is left eye hypertropia. This worsens on the left gaze and the right head tilt. There is a -1 degree limitation on depression on infra-duction. The yellow discoloration was due to fluorescein stain, which was used to detect any epithelial defect.
case_images: IMCRJ-18-99-g0001.jpg
case_images: PMC11745171_01_IMCRJ-18-99-g0001.jpg
case_images: f0001
case_images: In the primary position, hypertropia was noted in the left eye, and it increased in the left gaze with a right-side head tilt, consistent with inferior rectus muscle palsy (Figure 1).
case_images: Coronal cuts of computerized tomography image of a child with para-meningeal rhabdomyosarcoma. The star shows a soft tissue shadow in the left maxillary sinus extending into the left nasal cavity and the left extra conal orbit.
case_images: IMCRJ-18-99-g0002.jpg
case_images: PMC11745171_01_IMCRJ-18-99-g0002.jpg
case_images: f0002
case_images: Computed tomography (CT) of the head (Figure 2) revealed soft tissue density involving the left maxillary sinus extending into the left nasal cavity and left extraconal orbit.
case_images: Magnetic Resonance Images of the skull and orbits of a child with para-meningeal rhabdomyosarcoma. The right image is coronal cut T1 weighted and fat suppression with contrast. It shows a heterogeneous enhancing lesion of 37.6 mm x 38.4 mm in the left maxillary sinus isotense to the extraocular muscles, invading the left inferior rectus muscle and infraorbital fat. The left image is a coronal cut T2 weighted with contrast, showing the hyperintensity of the lesion to the extraocular muscles and enhancement.
case_images: IMCRJ-18-99-g0003.jpg
case_images: PMC11745171_01_IMCRJ-18-99-g0003.jpg
case_images: f0003
case_images: There was also an underlying abnormal marrow signal in the left posterior maxillary alveolus with abnormal thickening and signal in the gingiva, which was suspected to be a neoplastic process (Figure 3). 
case_images: The child's left eye with para-meningeal rhabdomyosarcoma ten days after initial presentation. The eye has lagophthalmos and severe conjunctival chemosis.
case_images: IMCRJ-18-99-g0004.jpg
case_images: PMC11745171_01_IMCRJ-18-99-g0004.jpg
case_images: f0004