1 - Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
2 - Radiology Department, Leiden University Medical Center, Leiden, The Netherlands
Congresso Nacional de Neurorradiologia, Aveiro, Portugal, 23 e 24 Outubro 2015
Introduction: Posterior scleritis is a rare and underdiagnosed vision-threatening condition. Although ultrasound is the imaging modality of choice in this pathology, CT and MRI are also relevant, and performed in diagnostically challenging cases. Knowledge of the normal and pathological scleral appearance is hence essential to the neuroradiologist. The purpose of this exhibit is to illustrate the possible imaging findings in scleritis and its main differential diagnosis, providing imaging pearls and pitfalls in this condition.
Results: The most common finding is scleritis is scleral enhancement, followed by thickening of the sclera and periocular cellulitis, but often signs of extraocular affections and complications can be seen and are better depicted than by ultrasound. Important differential diagnosis include uveítis, but also diffuse uveal melanoma and lymphoma for diffuse scleritis and metastatic disease and melanoma for nodular forms. MRI is of particular importance in this cases. Use of gadolinium is critical, and advanced techniques, like DWI can be extremely helpful in distinguishing benign from malignant lesions.
Conclusion: CT and especially MRI can differentiate scleritis from other orbital affections, also accessing potential complications and providing clues on etiology. Clinically the diagnosis can be challenging. It is therefore important that neuroradiologists are able to recognize the signs of this relevant disease process so that they can better aid their colleagues and patients starting potentially vision saving treatment or prevent unnecessary enucleations