 Hello everyone, today I am presenting a case series of multi compartmental orbital masses in the diagnostic insights on amyretic. Myself Dr. Sparshagravan from JJ Group of Hospital, Kondak. We all know orbit includes i-clobe and the rest of the soft tissues within the orbital zone. So, orbit under the axis of its extracellular muscle is divided into the compartments and the multi compartmental orbital masses are those which involve more than one and a total compartmental within the orbital. So, the diagnosis of multi compartmental orbital masses typically involves a combination of clinical examination imaging which includes CT scan and MRI and sometimes biopsy for histopath analysis. The multi compartmental orbital masses can arise from various types of tumors which could be benign or malignant, then inflammatory lesions, vascular or metastatic. So, the orbital anacomy involves, first of all there is i-clobe anteriorly with the extracellular muscles are seen inserting posterior to the lymph mass on the i-clobe with a wide insertion anteriorly and are seen converging posteriorly. At the level of orbital cortex, therefore giving a cone-like appearance with the structures within the cone given as intra-conal compartment and the structures outside the extracellular muscles are formed extra-conal compartment. So, intra-conal compartment includes the cone which is formed by the extra-conal muscles which are basically seven in number, four rectite, two obliques and one levitable pulmonary superior risk. And then there is intra-conal fat vessels and the nerves. The extra-conal compartment includes extra-conal fat in the lateral gland which is placed superior lagerally. In the basic MRI protocol for any orbital lesion involves screening sequence of the brain which is generally flared action and then the coronal and action thin sequences of the orbit which involves T2, T2 fat set, T1 and then T1 fat set sequence and post-contrast T1 fat saturated sequence. Now, coming to the case, in the first case, there were 38-year-old male patients who presented with a gradually progressive painless diminution of lesion in the right eye and bilateral supraorbital swimming since one year. There were no other comorbidities. The visual acuity of the right eye was finger counting from one meter and the left eye was standing on one, 6 by 20. One MRI and the first star coronal lesion, the right orbit shows an ill-defined homogeneously hyper-intensive lesion involving the entire right orbit with its expansion and the spread of the lesion in the right temporal region. It is the extraocular muscles cannot be deniated. The lesion is almost entirely involving the right orbit. And the similar intensity lesion is seen in the left orbit involving mainly in the superior temporal region, the extraoclonal thompatoid which spread in the frontal temporal soft tissue, subcutaneous soft tissue. The lesion shows intense effusion restriction on both sides with a corresponding trough and there is homogenous post-contrast enhancement. Similar intensity lesions are also seen in the spine involving the lower dorsal lumbar and sacral vertebral cortex. So the diagnosis on the basis of this findings is orbital lymphoma. This is another case of orbital lymphoma involving the left orbit extra as well as intra-conal superior aspect of left orbit with extension into the frontal sinus with reach in the frontal bone. And the post chemotherapy, there is significant resolution with residual lesion seen in the superior aspect of the arm. There was retinal detachment associated with detachment in the left arm. Second case is of 11-year-old male child who presented with swelling in the right eye since two months. It was not associated with pain, redness or any discharge. On MRI, the lesion appears to be heterogeneously hyper intense on star coronal image mainly involving the superior aspect of the right orbit involving the intra as well as extraoclonal compartment. The lesion is seen spreading into the right frontal sinus as well as there is intra-cranial extension into the extra axial space in the right basic frontal region. The lesion does not show any obvious diffusion restriction. However, it shows homogenous post-contrast enhancement and there is reach in the right frontal bone. Since the age of the patient is 11-year-old, the diagnosis of rhabdomyosarcoma was confirmed on biopsy. And this is the follow-up MRI of the patient after around nine cycles of chemo-regime which shows significant resolution with only residual soft tissue post-contrast enhancing soft tissue seen in the superior aspect of the right orbit and significant reduction in the mass effect and the size of the lesion. A 66-year-old female presented with orbital pain and gradually increasing swelling in the left eye since two years with left eye proptosis. There were no visual complaints, no eye discharge or redness. The patient was known hypertensive since 10 years. On MRI, there is the lesion appears to be heterogeneously hyper intense on flare action involving mainly the intra-fondant compartment which then appears hypo to isointense on T2. There is no obvious diffusion restriction under the lesion appears the hypo intense on T1 action mainly involving the intra-fondant compartment of left orbit with proptosis of left eye. And there is homogeneous post-contrast enhancement. Since the patient did not have any medical history and no known comorbidity, the patient was not in a case of thyroid diagnosis of orbital pseudo tumor was made and it was proven on biopsy. This is another case of orbital pseudo tumor where there is involvement of bilateral orbit involving the intra as well as extra-fondant compartment of both orbits. Predominant involvement can be seen on the right side with micro-moderate proptosis of right eye and then there is homogeneous post-contrast enhancing soft tissue. There is no obvious diffusion restriction even in this patient. So this was also diagnosis orbital pseudo tumor and it was proven on biopsy. This is another such case of a 42-year-old lady who presented with headache and swelling in the left eye which was progressively increasing since four months. This patient has a history of hyperthyroidism since one month. And in this case we can see that there is involvement of both the orbits with predominant involvement on the left side. We can see that the eyelids are also showing high-co-intense soft tissue in the T1 axial sequence with involvement of the retro-orbital fad. Additional finding in this patient was that both the eye-extraclular muscles are showing bulky belly with the sparing of the tendinous insertion. Then there was a progenous post-contrast enhancement of the head-touch soft tissue of both the orbits. This was this home case of hyperthyroidism. This was diagnosis thyroid ophthalmopathy. This patient was put on steroids and showed drastic response. 30-year-old female operated case of left side salivary duct carcinoma received radiotherapy and now presented with left eye proproses and diminution of vision since last two months. This patient shows on MRI. We can see that there is flare hyper-intense intra as well as extraconal soft tissue region involving the retro-orbital region. Then there is involvement of left optic nerve and the perineuron sheet. Then the lesion is seen extending into the cavernous sinus. Then there is involvement of the left side of the acyl system as well as the lesion is showing an expansion into the extension into the meccanus tube with its extension. Then the post-contrast sequence shows there is homogenous enhancement of the entire soft tissue. The basal system, the meccal scale from the adjacent ura cavernous sinus and then the orbit. So that's the extensive perineural spread of the metastasis. Then seven-year-old male child has entered with sudden onset proptosis of left eye. There was no history of pain, redness or discharge, no history of vision loss. In MRI, we can see a lobulated multi-systic lesion with the variable size cystic spaces showing fluid, which appears flare. It shows fluid levels on T2 flare sequences and the fluid appears hyper-intense on T1 with blooming on SWS registry of hemorrhage content. There was no associated diffusion restriction. On post-contrast sequence, we can see that the lesion does not show any obvious enhancement on the brain enhancement can be seen. There is significant mass effect in the form of displacement of the eye globe laterally and optic nerve. So the diagnosis of venolymphatic malformation was different. Another such case of multi-systic lobulated lesion involving the intra as well as extraponal compartment in the left eye causing mass effect in the form of anterior displacement of left eye. With proptosis and in the multi-systic spaces show fluid fluid level, there is no obvious enhancement. So there is no venolymphatic malformation. Last case is of a 32-year-old male patient presented with sudden onset painful diminution of vision in left eye when altered sensorium sends one way. Patient is a known case of diabetes malitis on treatment since last one year. There is no history of trauma. On MRI, we can see that there is heterogeneously hyper intense soft tissue involving the intra as well as extraponal compartment of the orbit. And the soft tissue is also seen extending into the presectoral region, mainly in the medial aspect of left eye. There is a stern hyper intense collection in the bilateral etymoid paranesal sinuses and bilateral frontal paranesal sinuses. So there are two well defined large T2 hyper intense lesions are seen in the basic frontal region in both the frontal lobes. There is a T2 heterogeneous content within the lesions and there is significant perillational edema. The lesions show intense homogenous restriction and peripheral limb enhancement can be seen on the post contrast suggesting of cerebral abscess. The orbital soft tissue also shows homogenous post contrast enhancement. The left maxillary sinus shows peripheral mucusal hyper enhancement. Overall findings are suggestive of thin basin frontal sinusitis with preseptile and orbital cellulitis with intracranial extension in bilateral large cerebral abscesses with significant perillational edema. So on the basis of MRI we can differentiate multi compartmental lesions. Lymphoma on MRI appears as a iso intense on T1 and hyper intense on T2 with homogenous post contrast enhancement. The lymphoma generally shows intense diffusion restriction with a drop on ADC which is the characteristic feature of lymphoma which helps in differentiating it from pseudo dimmer and other inflammatory lesions. They are generally seen in the elderly age group and with more than 60, more than equal to 60 years of age. They are generally monolateral and extra tonal involving the superotemporal region and like Randolph however, they can be multi compartmental. Metastatic lesions are they are around 1 to 30 and compass around 1 to 13% of orbital tumors and they are the most common cancer to metastasize as the breast cancer. Generally the imaging findings are not any characteristic findings of metastatic. They generally have iso to hyper intense lesion on T2 and hyper intense on T1 with homogenous post pattern. They generally present with a known history and that helps us in diagnosing it as a metastatic lesions. Lymphatic malformation is generally present in the pubertal and adolescent age group and with a significant orbital swelling and proposes as the main presenting complaints. They are also known as lymphoma generally extra tonal but they can be multi compartmental. Then the sudden increase in proposes indicates that the hemorrhage within the situation. On MRI the characteristic appearance is a fluid fluid levels on T2 sequence with some sort of blooming on him as a gradient sequence as a stream of hemorrhage within the system. They generally present with a modulated metastatic lesion. The orbital supertumor are the idiopathic inflammatory lesions generally presenting in 4 to 6 seconds are the most common painful orbital mass in the adults. They are the third most common orbital lesion after thyroid ophthalmopathy and lymphoma. They are generally the diagnosis of exclusion. The characteristic MRI finding is the iso to hyper intense on T2 sequence. They do not generally show any diffusion restriction that is intense homogenous post contrast enhancement. The differentiating point between the orbital supertumor and the thyroid ophthalmopathy is the involvement is generally. The extracellular muscles involvement, the pseudo tumor involves a tendinous insertion while the thyroid ophthalmopathy spares tendinous insertion of the extracellular muscles. The raptomaya sarcoma is a tumor of the children. They generally present in the childhood. The head and neck and the orbit are the most common sites of raptomaya sarcoma. They have a rapid clinical history would generally present with a rapidly announced growing mass. The biopsy is mandatory for diagnosis MRI. The lesion will appear iso to hyper intense to extrocular muscles on T1, hyper intense on T2 with homogenous post contrast. Since the lesion is relevant, there is there can be associated bone erosion and intracranial extension. There is a locally aggressive fungal infection with, which simply involves the paranescent sinus and extension into orbit and brain by a direct spread or through vascular channels. The risk factors include uncontrolled diabetes malitis, iron overload, immunocompromised state and chronic steroid intake. The characteristic MR sign is a black turbinate sign, which is that the turbinates appear, hyper intense on T2 and post contra sequence and does not show homogenous enhancement. The obliteration of parenteral or retroenteral fat is an early indicator of the spread of the fungal sinusitis. The orbital extension can result in orbital apex syndrome or panophthalmitis. Intracranial extension can result in meningitis, extradural or intradural intraparent canal abscesses. These are my references. Thank you.