Subperiosteal orbital abscess associated with ethmoid sinusitis

History: 11-year-old boy with a swollen right eye

Findings: Axial and coronal contrast-enhanced CT images through the midorbit demonstrate a low attenuation, peripherally enhancing extraconal fluid collection within the medial aspect of the right orbit. There is lateral displacement of an enlarged medial rectus muscle on this side as well as opacification of the right ethmoid sinus.

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Diagnosis: Subperiosteal orbital abscess associated with ethmoid sinusitis

Discussion: Infections and inflammatory conditions commonly involve the orbit and periorbital regions in children. Preseptal cellulitis involving the eyelid and surrounding facial soft tissues can be successfully treated with antibiotics. Postseptal cellulitis is a significantly more serious condition that often necessitates surgical drainage. This case demonstrates a typical subperiosteal abscess located along the medial orbital wall. This condition is usually associated with sinusitis. CT scanning is indicated whenever orbital cellulitis is clinically suspected. Without prompt treatment further complications can result, including development of intracranial abnormalities such as subdural empyema or cavernous sinus thrombosis.

Subdural empyema is a collection of pus between the dura mater and the underlying arachnoid mater. Symptoms of epidural abscess include fever, headache, vomiting, and sometimes lethargy, focal neurologic deficits, seizures, and/or coma.

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Aunt Minnie’s Pearls
– A subperiosteal abscess occurs in the postseptal extraconal space of the orbit and is associated with acute bacterial sinusitis.
– Surgical drainage is usually indicated to prevent sever sequalae such as subdural empyema or cavernous sinus thrombosis.

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