Orbital cellulitis with a subperiosteal abscess
Left sided orbital cellulitis. Unable to open eye fully.
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Extensive opacification of all of the left paranasal sinuses with obilteration of the left osteomeatal complex.
Elliptical left subperisoteal collection adjacent to the ethmoid sinuses with displacement of the medial rectus muscle.
No bony destruction at the collection site. No intracranial extension.
Imaging of the orbits, paranasal sinuses and brain ( ideally with contrast ) is a very important radiological emergency in selected patients, typically children, with orbital cellulitis.
The scan has three chief purposes:
1. Is there a subperiosteal collection?
2. It there any intracranial extension?
3. Is there underlying severe sinusitis?
This case shows the typical 'positive' scan - a subperiosteal collection, which warrants prompt treatment to prevent any threat to vision.
Emergency fibre optic endoscopic surgery was performed - pus drained from the maxillary and ethmoidal sinuses.