Orbital Lesions by Anatomic Compartment: A Practical Differential

A practical radiology review of Orbital Lesions by Anatomic Compartment: A Practical Differential, focused on imaging findings, differential diagnosis, reporting points, and high-yield teaching pearls.

• MS neuritis = T2 bright + enhance
• ION = sudden painless + restricted DWI
• Glioma (NF1) = tortuous nerve
• Meningioma (NF2) = “tram-track”

Intraconal

• CVM = slow, delayed fill ⏳
• Varix = grows w/ Valsalva
• LM = cystic + fluid-fluid

Conal (EOMs)

• TED = “I’M SLOw” Coca-Cola bottle
• Myositis = tendon involved
• IgG4 = lat rectus nerves
• Lymphoma = restricted DWI

Extraconal

• Cellulitis = pre vs post septum
• IH (infant) = flow voids
• Rhabdo = kids + restricted DWI
• Schwannoma = hetero, NF2
• Neurofibroma = “target sign”

Lacrimal

• Pleomorphic adenoma = painless
• Adenoid cystic = painful, PN spread
• Lacrimal lymphoma = restricted DWI

Globe