From the Guidelines
The most appropriate diagnostic imaging study for this 12-year-old patient is a contrast-enhanced CT scan of the orbits and sinuses. This patient's presentation with eye redness, swelling, proptosis, and painful extraocular movements, combined with nasal congestion, facial pressure, and cough, strongly suggests orbital cellulitis secondary to sinusitis, as indicated by the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1. The recent ACR Appropriateness Criteria for orbital imaging and vision loss in children also supports the use of CT scans for suspected orbital or periorbital infection, highlighting the importance of differentiating preseptal cellulitis from postseptal cellulitis and abscess, and identifying underlying sinusitis and intracranial complications 1.
Key points to consider in this case include:
- The patient's symptoms of proptosis, impaired, and painful left extraocular movements are indicative of postseptal inflammation, which requires prompt imaging to determine the extent of infection and potential complications.
- Contrast-enhanced CT scans are preferred for their ability to visualize both orbital structures and paranasal sinuses, allowing for the identification of orbital abscess formation, subperiosteal abscess, or sinus disease that may require surgical intervention.
- MRI could provide better soft tissue detail but is typically reserved for cases where intracranial extension is suspected or when CT findings are equivocal, as suggested by the clinical practice guideline 1.
- The choice of imaging modality is critical because orbital cellulitis can lead to serious complications, including vision loss, cavernous sinus thrombosis, or intracranial spread if not promptly diagnosed and treated, emphasizing the need for urgent treatment with intravenous antibiotics targeting common sinus pathogens.
From the Research
Diagnostic Imaging Study
The patient's symptoms, including redness and swelling around the left eye, proptosis, and impaired extraocular movements, suggest a possible orbital infection or inflammation.
- The most appropriate diagnostic imaging study for this condition is not explicitly mentioned in the provided studies.
- However, based on the patient's symptoms, a contrast-enhanced CT scan of the orbits and sinuses may be considered to evaluate for possible orbital cellulitis, abscess, or other complications 2.
- It is essential to note that the choice of diagnostic imaging study depends on the suspected diagnosis and the patient's clinical presentation.
- The American College of Radiology Appropriateness Criteria can be a useful resource in determining the most appropriate imaging study for a given clinical scenario 2.