Introduction

Cysticercus cellulosae is a larval form of Tenia solium which infests humans in endemic regions by ingestion of ova-contaminated food or internal autoinfection [1]. The involvement of the orbit and adnexa occurs in 5–8.4 % of all ophthalmic cases [2, 3]. The extraocular muscles are most commonly involved [4]. The orbital ultrasonography and computed tomography are useful diagnostic tools for confirming the diagnosis [5]. However, the varied presentation and absence of typical radiological signs in some cases makes the diagnosis challenging. We here describe the use of a smart phone in the out-patient clinic as a useful adjunctive tool for the study of computed tomography images for making a diagnosis of orbital myocysticercosis.

Case report

A 20-year-old male presented with the history of left eye proptosis of 2 months duration, which was gradually progressive and painless. He was a non-vegetarian and there were no significant systemic and family history. On examination, his uncorrected visual acuity in both the eyes was 20/20. The Intraocular pressure was 16 mmHg in both the eyes while the rest of the anterior segment examination was essentially normal. The patient was orthophoric in primary gaze and ocular movements were full and free in the right eye and there was −4 restriction in upgaze (0 means full movement i.e. temporal limbus touching lateral canthus and −4 means no movement, i.e. eye not crossing midline) in the left eye. There was a proptosis of 2 mm on Hertel’s exophthalmometer at a base reading of 100. Systemic examination was unremarkable. Orbital ultrasonography (USG B scan) was done which showed thickening of the left superior rectus muscle with no obvious cystic lesion. Orbital computed tomography scan (CT scan) with axial and coronal cuts with sagittal reconstruction with a slice thickness of 2 mm was done, which showed the presence of diffuse thickening of the superior rectus muscle of the left orbit; however, there was no visible cystic lesion with hyperdense spot in the lumen (Fig. 1). A provisional diagnosis of thyroid ophthalmopathy, orbital myositis, and non-specific orbital inflammation was made. The CT scan films were marked and photographed by using a smart phone in the out-patient clinic due to the unavailability of the clinical photographer. On further examination of the images under high magnification, an ovoid cystic lesion with a thick enhancing peripheral rim and a hyperdense spot within the lumen suggestive of scolex was observed within the belly of superior rectus muscle (Fig. 2). The magnified CT scan image on the smart phone facilitated the final diagnosis of superior rectus myocysticercosis of the left orbit. The patient was administered oral albendazole 15 mg/kg body wt and prednisolone 1.5 mg/kg body wt for a period of 4 weeks. The patient returned at 6 weeks follow-up with complete regression of proptosis and motility restriction.

Fig. 1
figure 1

Sagittal cut of orbital computed tomography scan (CT scan) showed the presence of diffuse thickening of the superior rectus muscle of the left orbit

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Fig. 2
figure 2

The magnified view of the CT scan image showed an ovoid cystic lesion with a thick enhancing peripheral rim and a hyperdense spot within the lumen suggestive of scolex within the belly of superior rectus muscle

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Discussion

Orbital myocysticercosis is a relatively rare condition. The diagnosis of cysticercosis is based on orbital imaging because of its characteristic appearance. The characteristic radiological features of the cyst are a well-defined cystic lesion with a density similar to water or cerebrospinal fluid and a dense structure within the cyst which represents the dead or viable larva called the scolex. Both ultrasonography and CT scan play a vital role in making the diagnosis [6]. These imaging techniques would be helpful for documenting a cyst or calcification inside an extra ocular muscle. Such findings, however, may be very discrete and overshadowed by the marked enlargement of the muscle, usually extending far beyond the cyst, as occurred in our case [7]. On naked eye examination of the CT films against the view box, there was only gross thickening of the superior rectus muscle. Magnification of the captured images on the screen of the smart phone (12 megapixel inbuilt camera with Carl Zeiss lens), we could visualize a small cystic lesion with a central scolex lying within the belly of the superior rectus muscle. The patient responded well to the oral anti-helminthic therapy which was started immediately.

Smart phones are being used these days for patient education through various applications used in different platforms (I-phone, Android, Symbian). However, a literature search did not reveal any previous published report regarding the use of smart phones as an aid in OPD. A previous published study reports usage of smart phones by the radiologists for reading CT scan images to help in diagnosing appendicitis [8]. The magnified image obtained on the smart phone complimented the information available on the conventional CT scan film facilitating the diagnosis. To conclude, capturing a CT scan film image with a smart phone could be an adjunctive imaging tool which could aid in rapid diagnosis of selected cases of myocysticercosis with high clinical suspicion.