Craniofacial fibrous dysplasia/Intraosseous Meningioma/Lymphoma/Mets

This is an almost certainly case, probably representing craniofacial fibrous dysplasia with enlargement of the sphenoid on the right. This involves the greater wing of the sphenoid and produces mass effect on the adjacent orbit.

Although easily missed, there is also a mass centered in the left clinoid which was better seen on a subsequent study making meningioma or mets more likely.

The other differential considerations are Paget’s disease which tends to spare the facial Bones, intraosseous meningioma, sclerotic metastatic disease, or cemento-ossifying fibroma,Whatever that is. scr2cap_064118.png