A scintigraphic demonstration of a solitary orbital Paget’s disease

Excerpt

A 57-year-old woman was admitted to our department in 2012 due to a painless prominence in the right temple, diplopia and blurred vision of one-year duration. She denied previous trauma or thyroid disease. Moreover, the family history was negative for endocrine disorders. Computed tomography revealed a lesion 38 × 47 mm in size characterised by a marked thickening of the frontal bone in the area corresponding to the upper and lateral wall of the right orbit presenting lytic and sclerotic changes. As a result, the right medial rectus and inferior rectus muscles, as well as the right optic nerve were compressed. In the ophthalmic examination, a desaturation of colour vision in the right eye was observed, suggesting the right optic nerve neuropathy. Visual evoked potentials (VEP) analysis revealed a slight deterioration of the signal conduction in the optic pathway. Furthermore, a whole body ^99mTc scintiscan demonstrated a solitary area of increased radiotracer uptake in the right orbit (Fig. 1). In addition, alkaline phosphatase was elevated (225 U/l, normal 35–105), whereas calcium, phosphates and parathyroid hormone levels were within the normal range. Thus, a solitary orbital Paget’s disease (PD) was diagnosed. The case was consulted with an interdisciplinary team comprising an endocrinologist, an ophthalmologist, a neurosurgeon and a laryngologist. Taking into consideration the severity of changes and the patient’s opinion, a decision was made to implement a conservative treatment including close ophthalmic monitoring. A surgery was postponed until possible deterioration of symptoms.

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