Presentation
Left eye blurred vision and mild proptosis for 2 years.
Patient Data
Thickened sclerotic left greater wing of the sphenoid, encroaching upon the left orbit with an intra-orbital soft tissue component at the lateral wall.
Mild proptosis of the left eye globe.
The left greater wing of the sphenoid appears enlarged with an abnormal dark signal in the different pulse sequences (sclerotic). The adjacent intracranial extraaxial rim of soft tissue is seen along the anterior aspect of the left temporal fossa, which is isointense on T1 and hyperintense on T2, with homogeneous post-contrast enhancement. Another intraorbital extra-conal similar soft tissue component is seen along the lateral wall of the left orbit. It displaces the lateral rectus muscle medially and inferiorly, with consequent left eye globe mild proptosis.
Multiple foci of the hyperintense T2/FLAIR signal are seen at the juxta-cortical and deep white matter of both fronto-parietal lobes.
Case Discussion
CT and MRI features are characteristic of en plaque meningioma of the left sphenoid wing with anterior temporal and left orbital extensions, resulting in mild proptosis.
En plaque meningiomas are rare tumors that commonly affect the sphenoidal ridge. They infiltrate the adjacent dura and bone, resulting in hyperostosis. Differential diagnoses may include fibrous dysplasia, Paget's disease, neuroblastoma, or dural metastases.
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