Clinical Communication to the Editor| Volume 131, ISSUE 8, e337-e338, August 2018

Acute Onset Unilateral Proptosis

      A 70-year-old Caucasian woman with a medical history of chronic obstructive pulmonary disease, hypertension, and hypothyroidism presented with progressively worsening left ocular proptosis and eyelid swelling for 2 weeks and diplopia for 2 days. On physical examination she had left eye ptosis, proptosis, and limited upward, left, and right lateral extraocular movement (Figure, A). Hemoglobin was 9.3 g/dL, white blood cell count 16.1 K/µL, platelet count 78 K/µL, and lactate dehydrogenase 1681 U/L. Peripheral blood smear was reviewed (Figure, B). Computed tomographic angiography of the head showed a retro-orbital mass. A whole-body positron emission tomography scan showed soft tissue lesions in the left posterolateral chest wall, iliac fossa, and sacral and presacral regions, and a left extraconal mass, all with increased fluorodeoxyglucose uptake (Figure, C). Bone marrow and chest wall mass were biopsied (Figure, D).
      Figure(A) Unilateral proptosis and impaired left eye upward gaze. (B) Peripheral blood smear. (C) Positron emission tomography scan with increased fluorodeoxyglucose uptake in left extraconal mass viewed on coronal plane. (D) Bone marrow aspirate.
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