Presentation
Right eye swelling, fever and preauricular swelling for 5 days.
Patient Data
Significant thickening with fat stranding over the right preorbital/preseptal space. Peripherally enhancing collection seen within the space between both superior and inferior tarsus with the cornea. A small air locule trapped within the collection at inferior tarsus. Soft tissue attenuating collection noted at the right medial canthus. No obvious extension into the right lacrimal sac and nasolacrimal duct.
Extension of the soft tissue lesion and fat stranding posterior the right orbital septum medially. No subperiosteal abscess.
Right extraocular muscles are all intact without swelling to suggest intramuscular abscess.
Right optic nerve complex is normal in caliber.
No collection within the conal and intraconal compartments of right eye.
Normal caliber and enhancement of right superior and inferior ophthalmic veins without thrombosis.
No right eye proptosis.
Left eye is normal.
No abnormal leptomeningeal enhancement or focal enhancing brain lesion. Cerebral venous sinuses and cavernous sinuses are well opacified without thrombosis.
Fat stranding noted along the subcutaneous fat region of right buccal space along region of right parotid/Stesen duct with ill defined heterogeneously enhancing swelling right parotid salivary gland, predominantly affecting the superficial lobe. No specific rim enhancement to suggest intraparotid abscess. No calcification at the right Stensen duct.
No opacification seen within both middle ear cavities and external auditory canals. Normal middle ear ossicular chain.
Paranasal sinuses and mastoid air cells are clear. Post maxillary sinus fat are clear bilaterally.
Annotated images showed the thickening of right periorbital tissue, enlarged right parotid salivary gland, normal caliber of superior ophthalmic vein and the collection at right lacrimal sac.
Case Discussion
Right orbital cellulitis with right parotitis. The right parotitis is likely to be result of secondary inflammatory/infective process. No CT evidence of intracranial extension or paranasal sinusitis.
Patient was admitted for intravenous antibiotic for one week and made uneventful recovery.
It is important for radiologist to differentiate between periorbital cellulitis and orbital cellulitis by assessing whether the infection has spread beyond the anatomical landmark of orbital septum. The treatment/management of the both entities are different, where orbital cellulitis requires hospital admission for intravenous antibiotic.
The related complications superior ophthalmic vein thrombosis, cavernous sinus thrombosis, meningitis and intracranial abscess should be assessed.
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