Orbital Hemorrhage in a Newborn

Orbital Subperiosteal Hematoma in the Newborn Causing Unilateral Proptosis: Ultrasound as First-Line Imaging Modality

“…3 Coagulopathy does not seem to be common as evident from the normal results of coagulation screens obtained in the reported cases. [2][3][4][5][6][7][8] Administration of vitamin K at birth needs to be ascertained in all cases. In one infant, preexisting coagulopathy and thrombocytopenia were aggravated by anticoagulation for extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure; 5 this infant developed proptosis secondary to subperiosteal orbital hematoma, which was confirmed by contrast-enhanced MRI and which resolved spontaneously.…”

“…The loose attachment of the periosteum to the bone in the superolateral aspect of the orbit in infants may explain the characteristic location in all reported cases, including the two cases presented here. [2][3][4][5][6][7][8]10 In one previous case, a subperiosteal hematoma with periosteal defect leading to leaking of blood into the orbit was found at the time of surgical exploration. 3 Coagulopathy does not seem to be common as evident from the normal results of coagulation screens obtained in the reported cases.…”

“…[2][3][4][5][6][7][8]10 In one previous case, a subperiosteal hematoma with periosteal defect leading to leaking of blood into the orbit was found at the time of surgical exploration. 3 Coagulopathy does not seem to be common as evident from the normal results of coagulation screens obtained in the reported cases. [2][3][4][5][6][7][8] Administration of vitamin K at birth needs to be ascertained in all cases.…”

“…5,6,8 Of the seven cases reviewed, six, including the second infant in our series, had undergone an orbital CT at some stage; in two cases, this was the only imaging modality. [2][3][4][5][6][7][8] Orbital MRI was used in three cases, in two of which, it was the only imaging modality. 5,8 The advantage of MRI in this context is the lack of radiation exposure, ability to reliably exclude an orbital encephalocele, and to differentiate blood at different stages of degradation.…”

“…6,8,15,16 Orbital ultrasound has been employed in two cases as initial imaging modality in one and for follow-up in the second case, but no images have been provided. 2,3 Reported ultrasonographic features include a well-demarcated homogenous retroorbital mass with low to medium reflectivity and sound attenuation and absence of calcification. 2,3 In the case reported by Kurlemann et al, orbital ultrasound on day 9 of life demonstrated a homogenous, clearly demarcated hypoechoic/cystic lesion consistent with a hematoma in resorption.…”