Metastatic Sinonasal and Right Orbital Adenocarcinoma Secondary to Right Breast Lesion

Matthew P. Nemoy; Macksood Aftab, DO, MHA, ALM, CAQ


Appl Radiol. 2019;48(2):32-33. 

In This Article

Case Summary

A 58-year-old woman with a medical history significant for previously undiagnosed right breast mass of 18 months arrived at the emergency department following four to five weeks of blurry vision, facial pressure, and fatigue. The physical exam and nasal endoscopy were unremarkable. Imaging, which included CT brain, MRI brain, and CT sinuses, demonstrated hyperdense soft-tissue opacification of the right frontal, sphenoid sinuses, and ethmoidal air cells with corresponding decreased T2 signal and osseous erosive changes involving medial orbital wall with soft tissue extending to the orbital apex. Diffuse pachymeningeal enhancement involving the dura was noted, including asymmetric enhancement of the right cavernous sinus. Differential diagnosis included sinonasal metastatic disease or fungal sinusitis. After consultation with neuroradiology, the patient was transferred to a tertiary care center for surgical evaluation and debridement, which revealed adenocarcinoma of the sinuses.