Orbital Mass Detected with POCUS

A previously healthy 46-year-old female patient presented to the Emergency Department (ED) with a primary complaint of binocular diplopia worsening over the past 48 hours. Physical exam revealed minor left inferior lid ecchymosis and was significant for proptosis (Figure 1a). There was no pain on extraocular movements, erythema of either lid, induration, chemosis, ophthalmoplegia, relative afferent pupillary defect, or other features of orbital cellulitis. Point of care ultrasound (POCUS) of the globe and orbit was performed and demonstrated a hypoechoic mass within the left lateral rectus muscle (Figure 1b; online Video S1). The patient had orbital CT and MRI imaging revealing, “Two enhancing masses within the left orbit adjacent to or arising from the left lateral rectus muscle causing mild medial displacement of the left optic nerve and mild left proptosis. No evidence of extra orbital extension or perineural spread. Imaging findings nonspecific…”