Orbital infection, optic neuritis and cavernous sinus thrombosis complicating a purulent sinusitis
Diagnosis probable
Presentation
Left exophthalmos with painful periorbital swelling.
Patient Data
Age: 35 years
Gender: Male
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The MRI sequences demonstrate:
- opacification of the left ethmoid cells with peripheral mucosal thikening of the left maxillary and sphenoid sinuses. Gas-fluid level within the maxillary sinus with peripheral mucosal enhancement
- left proptosis grade I with oedematous infiltration and enhancement of the periorbital soft tissues
- Inflammatory stranding of the intraconal fat mainly around the optic nerve and internal quadrants with enhancement in keeping with a postseptal orbital cellulitis
- swelling with enhancement of the retrobulbar intra-orbital segment of the optic nerve and surrounding nerve sheath in keeping with optic neuritis
- the left cavernous sinus is moderately distended with area of filling defect indicating probably thrombosis
- swelling with enhancement of the orbital muscles
Case Discussion
MRI features are suggestive of purulent sinsusitis complicated by orbital infection (pre-and postseptal cellulitis) with optic neuritis and cavernous sinus thrombosis.
Additional contributor: Assoc Prof MF Rougui, head of ophthalmology department, CHU Benflis, Batna