Presentation
Unwitnessed fall at home. Left periorbital hematoma.
Patient Data
There is disruption of the inferior left orbital margin, irregularity of the lateral left orbital margin and opacification of the left maxillary sinus, consistent with fractures of the orbit.
No other fractures identified. The remaining paranasal sinuses and mastoid air cells are clear.
Left frontal pole intraparenchymal hemorrhage measures 1.7 x 1.0 cm with two further, smaller hemorrhagic foci in the right frontal lobe. Periventricular hypoattenuation in keeping with chronic small vessel ischemic change. Incidental note of cavum septum pellucidum and cavum vergae. Ventricular size is age appropriate and unchanged. No midline shift.
Multiple bony fragments superior to the dens are well corticated and appear chronic. Left orbital floor fracture is depressed by 3.5 millimeters. No evidence of rectus muscle entrapment, retrobulbar hemorrhage or proptosis. Hemorrhage partially fills the left maxillary sinus. Left periorbital hematoma.
Conclusion: Bilateral frontal intraparenchymal hemorrhages. Left orbital floor fracture.
Case Discussion
Radiographs demonstrating a left orbit floor fracture and associated opacification of the maxillary sinus (hemosinus). These findings were confirmed on CT, which also demonstrated multiple small foci of brain hemorrhagic contusions.
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