Periorbital cellulitis, also known as preseptal cellulitis is an inflammation and infection of the Botting, A.M.; McIntosh, D.; Mahadevan, M. “Paediatric pre- and post-septal peri-orbital infections are different diseases”. International Journal of . Request PDF on ResearchGate | Paediatric Post-septal and Pre-septal Pre-SC and post-SC are also known as periorbital and orbital cellulitis, respectively. Celulitis orbitaria complicada por absceso subperióstico debido a infección por. Request PDF on ResearchGate | On Dec 31, , Isabel Gimeno Sánchez and others published Celulitis preseptal y orbitaria.
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To assess the incidence and complications of pre-septal pre-SC and post-septal post-SC cellulitis over 10 years.
Pre-SC and post-SC are also known as periorbital and orbital cellulitis, respectively. Retrospective analysis of CT scans. Patients can develop solely superior or inferior abscesses that are difficult to identify by axial imaging alone, hence coronal reformatted imaging is essential. We recommend that all patients with a pot diagnosis of post-SC should undergo CT scan post-contrast orbits and post-contrast head, with multiplanar reformats and a careful review of the SOV and the cavernous sinus.
Put a Lid on Preseptal Cellulitis
Particular attention septl be paid to exclude intracranial complications including subdural empyema and cerebral abscess. Bacterial orbital cellulitis is an uncommon condition that previously was associated with severe complications.
It is classified as pre-septal cellulitis pre-SC and post-septal cellulitis post-SC based on the anatomical landmark, the orbital septum Figure 1. Pre-SC periorbital cellulitis is an infection of pr eyelid and surrounding skin anterior to the orbital septum and is usually caused by local trauma or arises from an infective origin of the skin and adnexae of the eyelid Figure 2. Post-SC orbital cellulitis is an infection of the orbital tissues posterior to the orbital septum Figure 3 and is usually a result of paranasal sinus disease PNSparticularly of the ethmoidal sinus.
The ethmoidal sinus is separated from the orbit by only the thin medial orbital wall the lamina papyracea Figure 4. Diagram showing the position of the orbital septum white arrows and pre-septal and post-septal spaces. Differentiation between the two, prompt diagnosis and early management are essential when these conditions are suspected, to avoid potentially catastrophic sequelae including loss of vision ppre intracranial complications such celukitis venous thrombosis and empyema.
Classification of orbital disease according to Chandler et al 2. Pre-SC and post-SC can be difficult to differentiate clinically 3 and, therefore, imaging is often required for confirmation of diagnosis and to evaluate for complications of post-SC. The aims of this study were to analyse the relative incidence of pre-SC and post-SC in the paediatric age group, the rate of complications and the use of CT in the diagnosis of this condition.
This was a retrospective review of patients who had CT scans of their orbits for suspected pre-SC and post-SC, in a tertiary-level paediatric hospital in the UK, over a year period.
A record of all patients who had CT scans of their orbits was obtained from the radiology database. Only patients with suspected pre-SC and post-SC were included in the study. Patients who had scans for trauma, tumour diagnosis or follow-up or for any other reason were excluded. CT reports were analysed for all included patients. The CT protocols were analysed with regard to views obtained axial, coronal and sagittalthe use of image reformats, the use of intravenous contrast and whether the brain was scanned.
The age of the patients ranged from 0 to 15 years mean age, 6 years. Pre- and post-contrast scans were obtained in 87 patients.
Pre-contrast axial images were obtained in 46 patients, axial images with coronal reformats in 34, and axial images with coronal and sagittal reformats in The respective numbers celulitie post-contrast views were 63, 43 and CT of the brain all post-contrast was performed in 84 patients. Among these, 30 were medial Figure 610 were superomedial, 3 were lateral, 2 each were anteromedial and inferomedial, and 1 each was superior Figure 7 and anterosuperior 1 not specified.
Axial CT showing a medial orbital abscess with air locules on the right white arrow and inflammation of the right ethmoidal sinus. Coronal CT showing superior orbital abscess on the left white arrow and inflammation of the right ethmoidal and septall sinuses. No other complications were recorded in the reports during the period of this study. Axial post-contrast CT of the brain showing a small right frontal subdural empyema black arrow.
Coronal T 1 weighted MRI showing a right cavernous sinus celulitus white arrow. Pre-contrast studies added no extra information to the post-contrast studies. Post-contrast studies allowed easier delineation of phlegmon from intraorbital abscess.
Similarly, intracranial subdural empyema was easier to visualize on post-contrast CT imaging. Post-contrast studies also added value by allowing diagnosis of srptal ophthalmic vein or CST that could not be appreciated with pre-contrast studies.
Celulitus major complications e. In our population, we noted peak incidence during winter and spring Figure Seasonal variation in the number of cases. There was a predisposition for the medial orbit 44 among the 50 were medial, anteromedial, superomedial or inferomedial. This is because of the close proximity of the ethmoidal sinuses to the medial wall of the orbit with only the thin lamina papyracea separating the two.
However, coronal imaging is essential, as pee small proportion of patients have collections localized to the superior or inferior orbit only, which delulitis be difficult to identify on axial imaging alone.
Multiplanar imaging in our study became easier with the installation of a multislice CT scanner roughly half way through the study recruitment period. Three patients had SOV thrombosis, and one patient had an isolated subdural empyema.
The SOV communicates directly with the cavernous sinus there are no valves between the two structures and this facilitates the direct extension of thrombus.
Orbital infection | Radiology Reference Article |
Despite modern antibiotic and anticoagulation therapy CST remains a condition with significant morbidity and potential mortality. We observed variation in scanning protocols among radiologists. Some did not routinely do pre-contrast views. There was limited use of reformatted images during the early years, whereas in the latter years, most radiologists performed reformats in at least two planes, namely axial celulotis coronal.
We did not see any benefit of routine pre-contrast CT, i. Discarding pre-contrast views also has the added advantage of dose reduction in the paediatric population, a population that is more susceptible to the harmful effects of ceoulitis. Post-contrast imaging allowed easier identification of prr only intraorbital abscess and subdural empyema but also of SOV and CST that were difficult to identify on pre-contrast scans.
Howe and Jones 5 recommend a CT scan in selected patients: On the other hand, Givner 6 proposed that if bedside examination cannot comfortably rule out orbital cellulitis or if orbital cellulitis is suspectedan orbital CT scan with contrast should be obtained. We would agree with the latter imaging policy.
Other features high neutrophil count, the absence of infectious conjunctivitis, periorbital oedema, age greater than yy years and previous antibiotic therapy can identify patients who do not have such predictors but do have significant risk of disease. These predictors could be used to better target patients for CT.
According to a study by Kapur et al, 8 MRI should be considered for cases in which there is clinical or CT-based suspicion for intracranial complications e. This is supported septa our study in which intracranial complications were confirmed using MRI. In another article, 9 the same team noted that diffusion-weighted imaging Spetal improved diagnostic confidence in nearly all cases of orbital abscess when used in conjunction with contrast-enhanced imaging.
We advise that an urgent ear, nose and throat ENT opinion should be obtained with a view to endoscopic drainage of the affected sinuses. Patients should be assessed for poat symptoms, including visual acuity and eye movements, and also for neurological symptoms that might indicate intracranial spread, and an urgent ophthalmological and neurosurgical opinion should be sought as required.
CT with contrast remains the optimal imaging study for orbital inflammation. We have shown that coronal imaging of the orbit is essential, particularly as in a small proportion of children post-SC collections are localized to the superior or inferior orbit.
Post-contrast imaging of the whole head is also essential in children with post-SC because, in a small proportion of children, subdural empyemas may occur. In a child with orbital cellulitis, prompt diagnosis and treatment is sepral in obtaining the best outcome.
Particular attention should celuljtis be paid to exclude intracranial complications, including subdural empyema and cerebral abscess.
If there is any concern about intracranial spread of infection, MRI should be performed to include DWI and post-gadolinium T 1 imaging. Neurology and ophthalmology opinions should also be sought early. The management of this condition requires a multidisciplinary approach, in which pos radiologist plays a vital role, to ensure the best outcome for the patient.
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Published by the British Institute of Radiology. Open in a separate window. Table ppost Classification of orbital disease celulitid to Chandler et al 2. Class Category Description 1 Pre-septal disease Eyelid swelling without proptosis, ophthalmoplegia or loss of vision 2 Orbital cellulitis Inflammation of the orbital fat, proptosis, restricted eye movements, colour desaturation 3 Subperiosteal ;ost Pus collection elevating the periosteum off the bony orbit 4 Orbital abscess Pus collection within the orbit 5 Cavernous sinus thrombosis.
Objectives The aims of this study were to analyse the relative incidence of pre-SC and post-SC in the paediatric age group, the rate of complications and the use of CT in the diagnosis of this condition. Moffet’s pediatric infectious diseases: The pathogenesis of orbital complications in acute sinusitis. An evidence based review of periorbital cellulitis. Clin Otolaryngol srptal Current treatment and outcome in orbital cellulitis. Aust N Z J Ophthalmol ; Howe L, Jones NS.
Clin Otolaryngol Allied Sci ; Periorbital versus orbital ppost. Pediatr Infect Dis J ; MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: MRI of orbital cellulitis and orbital abscess: Support Center Support Center.
Eyelid swelling without proptosis, ophthalmoplegia or loss of vision. Inflammation of the orbital fat, proptosis, restricted eye movements, colour desaturation.