Orbital cellulitis

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Left orbital swelling and redness

Patient Data

Age: 15 years
Gender: Male
mri

Loculated fluid collection is seen at the right upper eyelid, measures 8 mm in thickness and 17 mm in side to side dimension, showing T1 hypointensity and T2 and FLAIR hyperintensity with enhancing walls, likely representing small abscess.

This is surrounded by inflammatory phlegmon at the upper eyelid, extending to intra-orbital space at extra-conal location. It shows diffuse T2 hyper-intensity and diffuse post-contrast enhancement.

Minimal enhancing of the left frontal meningeal reflection. 

No definite extra-axial brain collection. 

Also noted left ethmoidal air cells and left frontal sinus are opacified with T1 hypointense and T2 hyperintense fluid, reflecting left frontal and ethmoid sinusitis.

No signs of dural venous sinus thrombosis.

Case Discussion

Overall picture reflecting left orbital preseptal cellulitis with minor post-septal extension mostly sequel to complicated left frontal and ethmoidal sinusitis.

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