Orbital cellulitis complicated by superior ophthalmic vein and cavernous sinus thrombosis

Case contributed by Derek Smith


Left orbital swelling, proptosis and diplopia. Unwell for about 24 hours, now pyrexial. Vision preserved.

Patient Data

Age: 16 years
Gender: Male

Left orbital cellulitis involving pre and post-septal compartments. No definite post-septal collection or subperiosteal abscess.

Opacification of the left sided frontal, ethmoidal and maxillary sinuses in frontal recess obstruction pattern.

Reduced attenuation and relative swelling of the left superior ophthalmic vein and cavernous sinus.

Limited additional information on unenhanced MRI: fluid sinus opacification, left superior ophthalmic vein swelling and abnormal FLAIR signal in left cavernous sinus. Limited resolution on time-of-flight venogram. No definite optic nerve signal abnormality, but no fat suppression technique. No extra-axial collection or parenchymal signal abnormality.

Case Discussion

This case of orbital cellulitis spreading from a pansinusitis has subtle but important findings to comment on. CT and MRI demonstrate thrombosis of the left superior ophthalmic vein and the left cavernous sinus.

The patient was managed with surgical sinus drainage (confirming Moraxella catarrhalis infection) and oral antibiotics, as well a course of anticoagulation to address the venous thrombosis.

No clotting disorder was identified and there was good resolution on clinical and imaging follow up.

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