Wk 1, Case 4 - Review

Report

EXAM: CT ORBIT W/ CONTRAST COMPLEX

INDICATION: Left facial swelling and pain with eye movement; limited Left eye abduction on exam; concern for orbital vs. preseptal cellulitis

TECHNIQUE: Contrast-enhanced helical CT images were obtained of the orbits with multiplanar reformations.

COMPARISONS: None

FINDINGS:

There is a subperiosteal phlegmon versus abscess involving the medial left orbit measuring approximately 14 x 9 x 4 mm (anterior-posterior, craniocaudal, transverse), associated with contiguous spread of inflammatory changes arising from the opacified left ethmoid air cells. There is moderate mucosal thickening also seen within the left maxillary sinus.

The medial rectus muscle is displaced laterally by the subperiosteal collection and contacts the midportion of the intraorbital left optic nerve. There is inflammatory stranding involving the medial rectus and superior oblique extraocular muscles, as well as the adjacent extraconal and intraconal fat. The optic nerve/sheath complex maintains normal caliber and attenuation. The left ocular globe is normal in appearance. There is mild preseptal periorbital soft tissue swelling mostly along the infraorbital rim.

The left superior ophthalmic vein and cavernous sinuses are normal in appearance.

There is asymmetric thinning of the left lateral lamella, without frank evidence of focal dehiscence of the anterior cranial fossa floor or evidence of an intracranial subperiosteal/epidural collection.

The brain demonstrates normal enhancement. There is no hydrocephalus.

The right orbital structures are normal in appearance.


IMPRESSION:

1. Medial left orbital cellulitis as detailed above with a subperiosteal phlegmon/abscess along the medial left orbital wall, in keeping with contiguous spread of inflammatory changes from the adjacent opacified ethmoid air cells. There is involvement of the medial rectus and superior oblique muscles and contact with the optic nerve.

2. Asymmetric thinning of the left lateral lamella along the floor of the anterior cranial fossa adjacent to the inflamed ethmoid air cells. Although no intracranial collection or focal inflammatory changes seen, cannot exclude intracranial spread of inflammation. Further evaluation could be obtained with an MRI of the brain.