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Diagnóstico por Imagem da Órbita - R3 Lucas Teodoro

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Aula ministrada pelo R3 Lucas Teodoro a respeito dos principais diagnósticos diferenciais de patologias da órbita na TC e RM.

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Diagnóstico por Imagem da Órbita - R3 Lucas Teodoro

  1. 1. RESIDÊNCIA DE RADIOLOGIA E DIAGNÓSTICO POR IMAGEM DIAGNÓSTICO POR IMAGEM DA ÓRBITA R3 Lucas Teodoro
  2. 2. RM T2 STIR
  3. 3. RM T2 STIR RM T1 STIR C/C
  4. 4. DUCTO LACRIMAL DILATADO DEVIDO A VÁLVULA DE HASNER OBSTRUÍDA.
  5. 5. TRAUMA • TC É O EXAME DE ESCOLHA. • Corpo estranho • Complicações • Blowout
  6. 6. CONTRA INDICAÇÕES DA RM • Corpos estranhos ferromagnéticos • Clip metálico • Marcapasso • Implante coclear
  7. 7. TRAUMA DO GLOBO OCULAR • Rotura do globo ocular • Luxação do cristalino • Hematomas intra ou retro-ocular • Fistulas carotídeo-cavernosas
  8. 8. Evaginação do conteúdo orbitário
  9. 9. Fratura complicada
  10. 10. Blowout inferomedial
  11. 11. Corpo estranho metálico
  12. 12. INFECÇÃO • 67.7 % dos casos ocorrem em pacientes com menos de 20 anos • Geralmente decorrem de sinusopatia ou celulite periorbitária • Intraconal x extraconal
  13. 13. ACHADOS CLÍNICOS • Edema palpebral • Dor • Diplopia • Proptose • Diminuição da mobilidade ocular
  14. 14. COMPLICAÇÕES • Trombose do seio cavernoso • Empiema • Abscesso intracraniano • Meningite
  15. 15. TUMORES INTRA-OCULATRES • RETINOBLASTOMA • HEMANGIOMA DA COROIDE
  16. 16. RETINOBLASTOMA • TUMOR OCULAR MAIS COMUM NA INFÂNCIA • 90% EM MENORES DE 5 ANOS SEM DIFERENCIAÇÃO ENTRE SEXOS • 3% DOS CÂNCERES ABAIXO DE 15 ANOS • BILATERAL EM 20-30 % • TRILATERAL ( PINEAL ) • TETRALATERAL ( SUPRASSELAR )
  17. 17. • FAMILIAR EM 40% E 10 % DOS BILATERAIS ( BRAÇO LONGO DO CROMOSSO 13 ) • PRINCIPAL SINAL CLÍNICO É A LEUCOCORIA • TC PRA VISUALIZAR AS CALCIFICAÇÕES ( 50% DOS CASOS ) • RM PRA VISUALIZAR EXTENSÃO EXTRA- OCULAR.
  18. 18. HEMANGIOMA DE COROIDE • ANOMALIA VASCULAR CONGÊNITA COMUM EM ADULTOS DE MEIA IDADE COM SÍNDROMES NEUROCUTÂNEAS. • CAVENOSOS, CAPILARES, MISTOS • ASSOCIADO A STURGE-WEBER • GLAUCOMA CONGÊNITO ALTERAÇÕES ANGIOMATOSAS DO CORPO CILIAR.
  19. 19. TUMORES DA BAINHA/ NERVO ÓPTICO • MENINGEOMA • GLIOMA
  20. 20. MENINGEOMA • SEGUNDO TUMOR MAIS COMUM DO NERVO ÓPTICO • MULHERES DE 40 ANOS COMPROPTOSE E PERDA DA VISÃO • ESPESSAMENTO DIFUSO DO NERVO ÓPTICO, COM CALCIFICAÇÕES E INTENSA IMPREGNAÇÃO PELO MEIO DE CONTRASTE
  21. 21. GLIOMA • TUMOR INTRA-CONAL MAIS COMUM NA CRIANÇA ( 75% ENTRE 1 E 7 ANOS ) • 50% NF1 • 4% DOS TUMORES ORBITÁRIOS • ASTROCITOMA PILOCÍTICO • LESÃO BENIGNA DE CRESCIMENTO LENTO, COM PREDOMÍNIO EM MENINAS
  22. 22. FISTULA CAROTÍDEO-CAVERNOSA • COMUNICAÇÃO DA CARÓTIDA INTERNA OU EXTERNA COM O SEIO CAVERNOSO • INGURGITAMENTO VENOSO DO GLOBO OCULAR E DA PALPEBRA • EXOFTALMO PULSÁTIL • OSTEOGENESE IMPERFEITA E EHLERS-DANLOS
  23. 23. TROMBOSE DA VEIA OFTALMICA SUP. • OFTALMOPLEGIA POR PARALISAR O IV-V-VI • PROPTOSE • DISCRETA OU AUSÊNCIA DE IMPREGNAÇÃO PELO MEIO DE CONTRASTE
  24. 24. HEMANGIOMA CAPILAR
  25. 25. HEMANGIOMA CAVERNOSO
  26. 26. VARIZES ORBITÁRIAS MASSA INTRACONAL SERPENTIFORME COM REALCE PROGRESSIVO
  27. 27. LINFANGIOMA • LESÃO EXPANSIVA BOCELADA E SERPIGINOSA, MAL DEFINIDA, NÃO CAPSULADA, PODENDO SER EXTRA OU INTRA-CONAL • CRINAÇAS E ADULTOS JOVENS • PROPTOSE SÚBITA ( HEMORRAGIA ) • RARAMENTE CALCIFICAÇÕES • IMPERGNAÇÃO HETEROGÊNEA • HIPERSINAL EM T 2 E COM NÍVEL LÍQUIDO- LÍQUIDO.

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