Presentation
Painful right proptosis.
Patient Data
Marked right proptosis and preseptal soft tissue swelling. Mild stranding of extraconal fat at superior orbit. Fusiform extraconal subperiosteal collection at the orbital roof, suggestive of subperiosteal abscess of the orbit. Mild enlargement of the right lacrimal gland.
Complete opacification of right frontal and maxillary sinuses as well as ethmoid air cells with thick walls, in keeping with chronic sinusitis.
Partial opacification of the left maxillary sinus and mild mucosal thickening of the left frontal sinus and ethmoid air cells. Aerated both sphenoid sinuses.
Case Discussion
Features are suggestive of subperiosteal abscess of the orbit and preseptal cellulitis secondary to chronic right-sided sinusitis. Another probable complication is the intracranial extension as extradural abscess, subdural empyema, frontal cerebritis, and brain abscess formation. These possibilities couldn't be completely excluded on a CT basis, so contrast-enhanced MRI was recommended. Postcontrast T1WI MRI is the most sensitive radiological technique for the detection of possible brain abscesses.
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