[Quiz on an unusual orbital masquerade syndrome].

BACKGROUND

After consulting the here presented CT-images of the orbit, the question was raised whether the ocular bulbus was really enucleated or the anamnesis was wrong and a lymphoma existed in the orbit. We will therefore discuss a case of a special follow-up after an enucleation with implantation of a "Bangerter Plomb".

CASE REPORT: In 1988 the patient, born on February 1, 1947, underwent an enucleation of the right eye with implantation of a "Bangerter Plomb" because of posttraumatic phthisis dolorosa. The postoperative follow up was complicated by a reactive psychopathological development with automutilation. In 1992, a Non-Hodgkin lymphoma of the mandibula was detected and treated. During the year of 1994, a painful swelling of the right orbit developed. The orbital CT suggested a recurrence of the lymphoma in the right eye, which seemed to be still in place. The biopsy however showed an abscess cavity and some parts of the Bangerter implant.

CONCLUSIONS

The abscess cavity with the connected muscles and the interruption of the optic nerve which was only partially visible simulated the presence of a bulbus; the rest of the implant, on the other hand, simulated the presence of a lymphoma. The two main reasons for the infection were an early dehiscence of the wound and the automutilation. This "syndrome of masquerade" could have been detected earlier if the ophthalmologists and the neuroradiologists would have discussed the CT-images together earlier.