Fig. 13

Orbital spread in a patient with histopathologically and microbiologically confirmed ROCM. Coronal CT image of the paranasal sinuses (a), obtained using the bone algorithm, reveals right ethmoid sinusitis (thin arrow). Note the subtle extra-conal fat stranding (thick arrow) and mild displacement of the right inferior rectus (dotted arrow). Based on the clinical suspicion of ROCM and CT findings a CE MRI was suggested. Coronal T2-FS image (b) confirms the soft tissue within the right extra-conal space (thick arrow), detected previously on the CT. CE FS coronal T1W image (c) demonstrates heterogeneous enhancement of the soft tissue (thick arrow). The patient underwent surgical debridement along with right turbinectomy and removal of the right lamina papyracae, followed by a post-operative CE MRI (d–f) follow-up. Coronal T2-FS (d) reveals worsening of the disease with a confluent soft tissue (thick arrow) involving the orbital fat and the extra-ocular muscles. CE FS coronal T1W image (e) reveals intense enhancement of the right orbital soft tissue (thick arrow). CE FS axial T1W image (f) reveals focal fungal invasion of the right optic nerve (stepped arrow)