32 year-old with proptosis

CT noncontrast axial

CT noncontrast axial

CT noncontrast coronal

Findings:

Diffuse enlargement of the ocular muscles
Sparing of the musculotendinous junction
Proptosis

DDX:

Inflammatory pseudotumor
Lymphoma
Sarcoid
Amyloid
Graves Disease

Diagnosis:

Thyroid Orbitopathy (Grave’s Disease)

Discussion:

Exopthalmos with bilateral enlargement of EOM
Increased intra-ocular fat
“I’M SLOW” – Inferior>medial>superior>lateral>oblique
Predilection for muscle bellies; spares tendons
Lymphocyte inflammatory process

Submitted by Sung Logerfo, MD, UW Neuroradiology