An 11 year old with breathing difficulty and left sided proptosis

An 11 year old with breathing difficulty and left sided proptosis

An 11-year-old with breathing difficulty and left-sided proptosis.

  • Axial T2 weighted images demonstrate an expansile multi cystic heterogeneously T2 hyperintense mass lesion filling the left ethmoid air cells and nasal cavity. Cystic spaces demonstrate T2 hypointense fluid-fluid levels, suggestive of haemorrhagic or proteinaceous content.
  • Coronal T1 and T2 weighted images demonstrate thick T2 hypointense peripheral rim and T1 hyperintensity within the cystic spaces.
  • Axial and coronal contrast enhanced T1 fat-suppressed sequences demonstrate heterogenous post-contrast enhancement with enhancement of the cyst walls.
  • Axial CT with coronal reformatted images demonstrate peripheral ground glass matrix, corresponding to T2 hypointense rim, with central hypodense areas. Proptosis of left globe seen on CT axial image.


Fibrous dysplasia of the left ethmoid (craniofacial FD)


  • Fibrous dysplasia is a developmental abnormality in which a defect in osteoblastic differentiation and maturation results in replacement of normal bone marrow with fibro-osseous tissue.
  • Types:
    Monostotic type – Ribs, proximal femur and craniofacial bones.
    Polyostotic type – two or more bones, most common in femur, tibia and pelvis.
  • Imaging:
    Well circumscribed lesions in characteristic locations with no periosteal reaction.
    CT demonstrates the ground-glass matrix.
    A thick sclerotic margin (‘rind’ sign) is characteristic.
    MRI demonstrates marked variability and can often resemble a tumor or aggressive lesion.

Differential diagnosis:

This depends on the location of the lesion.

Skull and facial bones: Paget’s disease, Simple bone cyst, Aneurysmal bone cyst.

Limbs: Admantinoma, Osteofibrous dysplasia, Non ossifying fibroma.

Dr. Akshay K,
Radiology Resident,
Manipal Hospitals Radiology Group.

Dr. Anita Nagadi,
Lead Head & Neck, Oncology
Senior Consultant Radiologist
Manipal Hospitals Radiology Group.