reunião de casos lilian lumi takito aperfeiçoanda de rdi da digimax (a1)
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Reunião de casos
LILIAN LUMI TAKITO
Aperfeiçoanda de RDI da DIGIMAX (A1)
www.digimaxdiagnostico.com.br
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Caso Clínico
• Feminino, 63 anos• Protrusão ocular à esquerda há 2 meses,
queimação no olho esquerdo, lacrimejamento, sem déficit visual, hipertireoidismo e hipertensão há 3 anos;
• Realizada TC de crânio (28/05/2014):
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TC de crânio
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RM de órbitas (14/06/14)
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STIR
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T1 FS Pós Contraste
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Hipóteses Diagnósticas
• Oftalmopatia tireóidea;• Pseudotumor orbitário;• Processos linfoproliferativos;• Amiloidose orbitária;• Processo neoplásico metastático.
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Oftalmopatia Tireóidea
• Autoimune;• Hipertireoidismo (doença de Graves);• Causa mais comum de doença orbitária;• 15-28% exoftalmia unilateral;• 80% exoftalmia bilateral;• Fase ativa progressiva: 1 a 3 anos;• Fase quiescente ou inativa: resolução da
infamação e aparecimento da fibrose.
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Oftalmopatia Tireóidea
• Inflamação, congestão, hipertrofia e fibrose da gordura e músculos orbitários;
• Aumento de volume dos músculos reto inferior, reto medial, reto superior e reto lateral;
• TC e RM: neuropatia óptica (hipertrofia dos músculos, gordura orbitários, ápice orbitário);
• Focos hipodensos na TC e hiperintensos em T2 na RM;
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Oftalmopatia Tireóidea
• Tratamento medicamentoso se fase inflamatória;
• Tratamento cirúrgico se neuropatia óptica compressiva.
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Referências Bibliográficas
• MACHADO, K. F. S.; GARCIA, M. M.; Oftalmopatia tireoidea revisitada. Radiol Bras. 2009; 42(4):261-266.
• GOLDENBERG, F. C.; Utilização da Ressonância Magnética na Análise das Medidas das Estruturas Orbitárias na Oftalmopatia de Graves. São Paulo. 2008.
• HASSO, A. N.; DRAYER, P. B.; et al. Órbita, Visão e Perda Visual. Colégio Brasileiro de Radiologia.