Intraocular silicone oil for retinal detachment in AIDS: CT and MR appearances

Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands

Introduction

Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Case Report. An 18-year-old man with severe head trauma was admitted to our hospital. Initial computed tomography (CT) revealed a high attenuation of intraocular silicone that could be mistaken for a hemorrhage. Ophthalmological examination and detailed ophthalmic history confirmed silicone oil in his eye for treatment of retinal detachment. Knowledge of the anatomical changes and radiological appearance of postsurgical findings following retinal detachment, including the surgical materials of silicone oil or bands, can prevent unnecessary alarm.

Conclusion

Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.

Intracranial Migration of Silicone Delaying Life Saving Surgical Management: A Mimicker of Hemorrhage

We present a case in which intraocular silicone injection for complex retinal detachment resulted in migration and distribution of silicone along the intracranial visual pathway, and ultimately throughout the ventricular system. Misinterpretation of this material as intracranial hemorrhage on outside computed tomography imaging delayed emergent repair of a Type A aortic dissection until the diagnosis was made on repeat imaging. A discussion of this case and salient computed tomography and magnetic resonance imaging characteristics of silicone is provided.

Intraventricular silicone oil

The authors report a case in which intravitreous silicone oil migrated into the ventricles. They note that intraventricular silicone oil can be misdiagnosed as intraventricular hemorrhage and neurosurgeons should be aware of this possibility.

This 58-year-old woman with a history of Type II diabetic mellitus and retinal detachment (resulting from diabetic retinopathy), which had been treated with intravitreous silicone tamponade, presented with dizziness and headache approximately 10 years after the intravitreous silicone treatment. Over the next 6 years she underwent 2 non–contrast-enhanced brain CT studies and 1 MRI study for evaluation of her symptoms. On CT scan, extension of the intraocular silicone along the optic nerve was evident. Two hyperdense nodules were observed freely floating in the right lateral and fourth ventricles, remaining in the nondependent portion of ventricles in both supine and prone positions. On T2-weighted MRI, the left orbital content and the intraventricular nodules all demonstrated chemical shift artifacts typically associated with silicone. The imaging findings were characteristic for intraventricular silicone after silicone oil tamponade. The patient's dizziness and headache were treated symptomatically and she was followed up at the outpatient department.

Migration of intravitreous silicone oil into the cerebral ventricles is a rare complication. Intraventricular silicone oil can mimic intraventricular hemorrhage. Radiographically, intraventricular silicone oil can be distinguished from hemorrhage as silicone oil tends to stay in the nondependent portion of the ventricle. Chemical shift artifacts on MRI may help establishing the diagnosis of intraventricular silicone oil. Currently, there is no consensus on surgical removal of intraventricular silicone oil, and in the majority of cases reported in the literature, the patients were asymptomatic.

Intracranial hyperdense subarachnoid perfluorocarbon droplets after attempted retinal detachment treatment

Unexpected intracranial foreign materials may pose a diagnostic dilemma. We present a case of a gunshot wound resulting in severe orbital trauma and open-globe injury. The patient was treated with vitreoretinal surgery and intravitreous perfluorocarbon liquid (PFCL) injection. Postoperative head computed tomography exam demonstrated migration of PFCL into the intracranial subarachnoid space.

MR imaging of intraventricular silicone: case report

A 42-year-old man with human immunodeficiency viral infection developed cytomegaloviral retinitis that was complicated by retinal detachment and was treated with an intravitreous injection of silicone. Fifteen months later, magnetic resonance imaging revealed intraocular and intraventricular silicone. Signal intensity characteristics and chemical shifts of silicone in the two locations were identical.