BD is a 76-year-old man who presented at the emergency room with a picture resembling orbital cellulitis. His right orbit appeared congested with marked chemosis, lid edema, and he had limitation of ocular movement. These findings combined with a significant degree of pain prompted the ER doctor to initiate antibiotic intravenous therapy. First-generation CT scanning showed only diffuse orbital opacification thought to be consistent with cellulitis. A-scan was later obtained and demonstrated enlargement of all of his extraocular muscles with massive low reflective thickening of the superior rectus. Increased echolucency in subtenon’s space was noted (Fig. 141). The diagnosis of acute inflammatory Graves’ disease with concurrent myositis was made and he was started on high-dose steroids with rapid improvement in the inflammatory symptoms.
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