This case of orbital cellulitis spreading from a pansinusitis has subtle but important findings to comment on. CT and MRI demonstrate thrombosis of the left superior ophthalmic vein and the left cavernous sinus.

The patient was managed with surgical sinus drainage (confirming Moraxella catarrhalis infection) and oral antibiotics, as well a course of anticoagulation to address the venous thrombosis.

No clotting disorder was identified and there was good resolution on clinical and imaging follow up.