The Case of Alfried von Trupp und Stahlbach

Images Otitis MediaReverse Migraine

Fig. 13.16a The radiograph of the orbit clearly shows a foreign body in the left eye. If visible during the clinical ophthalmo-logical examination, it can be removed without further imaging. b The axial CT through the orbit also demonstrates the foreign body; however, its precise location relative to the lens and the anterior chamber of the eye remains unclear. c The Comberg set aligns itself to the axis of the lens. The foreign body can now be localized relative to the lens axis and the metal ring in two projections.

Fig. 13.16a The radiograph of the orbit clearly shows a foreign body in the left eye. If visible during the clinical ophthalmo-logical examination, it can be removed without further imaging. b The axial CT through the orbit also demonstrates the foreign body; however, its precise location relative to the lens and the anterior chamber of the eye remains unclear. c The Comberg set aligns itself to the axis of the lens. The foreign body can now be localized relative to the lens axis and the metal ring in two projections.

Comberg scleral contact fens

Comberg scleral contact fens

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Endocrine Axis

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d The metal ring of the Comberg set is indicated in the drawing on the left. The axis of the Comberg set corresponds to the center of the circle on the right drawing. Now go ahead and sketch the foreign body into the diagram.

work, she is bothered particularly by increasing double vision. Her visual acuity has also dwindled. The endo-crinologist has diagnosed an endocrine orbitopathy, but conventional therapy has so far not led to any substantial improvement. For that reason, additional radiation therapy is being contemplated. Before this procedure, MRI is indicated to verify the diagnosis, to exclude other causes of exophthalmos, to rule out a potential compression of the optical nerve, and to document the pretreatment status. Paul and Joey cover the examination and analyze the images (Fig. 13.17). They know they have to carefully exclude the presence of a number of tumors that may cause exophthalmos.

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