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Orbital subperiosteal abscess

Case contributed by Huda B. Gharbia
Diagnosis almost certain

Presentation

Headache, fever, left orbital swelling and proptosis.

Patient Data

Age: 12 years
Gender: Male

Hypodense collection in superolateral aspect of left orbital cavity, displacing the globe and left lacrimal gland inferiorly.

Obliteration of left frontal, maxillary sinuses and anterior ethmoid cells on left side with hypodensity, thickened middle turbinate.

mri

Left orbital cavity, extraconal cystic collection in superolateral aspect, appears hyperintense in T2WI, shows restricted diffusion in DW/ADC sequences, no significantly enhanced post contrast, pushing the left globe and lacrimal gland, adjacent left extra-ocular muscles inferiorly, preserved bone marrow signal intensity of adjacent bones.

Left superior eye lid thickening and subcutaneous, interstitial fat stranding, orbital cellulitis.

Obliteration of paranasal sinuses on left side with hyperintensity T2W signal , restricted diffusion, mucosal thickening and marginal enhancement in t1_vibe post contrast.

Case Discussion

Left orbital cellulitis, with subperiosteal collection in superolateral aspect of left orbital cavity, causes orbital proptosis.

Extensive sinusitis of adjacent left paranasal sinuses.

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