Orbital abscess

Case contributed by A.Prof Frank Gaillard

Presentation

Previous projectile injury to face and prior neurosurgery. Now swelling.

Patient Data

Age: 31
Gender: Male
CT

There is a multiloculated rim enhancing collection present at the medial right orbit. There is a bony defect at the paramedian right frontal bone, through which there is further extension of rim enhancing collection.

There is communication of the collection with the frontal sinus and anterior ethmoid sinuses, which are opacified by fluid although they do not contrast enhance. In the left frontal sinus curvilinear hyperdensities may represent fragments of bone, although colonisation by fungal organisms may also give rise to this appearance.

The frontal sinuses are expanded and remodelled, most likely due to the presence of a mucocoele. In the frontal, nasal and bilateral maxillary regions there is contrast enhancing soft tissue induration compatible with periorbital cellulitis.

The orbital retrobulbar soft tissues are normal with no fat stranding or abnormal contrast enhancement. The superior ophthalmic veins are not dilated. The cavernous sinuses enhance normally.

The right frontal bone is thinned and irregular, although it is well corticated, with loss of the inner margin of the bone and scattered osseous fragments. This is probably a combination result of previous injury/surgery. Metallic foreign objects in the right frontal lobe are noted.

There is a small region of right frontal gliosis/encephalomalacia. Grey-white matter differentiation elsewhere is preserved. No other intracranial abnormalities identified The ventricles and cerebral sulci are age-appropriate. There is no midline shift or other evidence of increased mass effect.

Conclusion:

1. Multiloculated abscess centred at the medial right orbit with extension through a paramedian right frontal bone defect to lie extra-axial to the right frontal lobe, on a background of periorbital cellulitis. No involvement of the retrobulbar orbital fat is demonstrated on this study.

2. Probable underlying frontal mucocoele.

3. Retained right frontal lobe metallic foreign bodies.

Case Discussion

The orbital abscess was drained and diagnosis confirmed. 

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Case information

rID: 35613
Case created: 14th Apr 2015
Last edited: 28th Sep 2015
Inclusion in quiz mode: Included

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