Orbital magnetic resonance imaging profile and clinicoradiological correlation in COVID-19-associated rhino-orbital-cerebral mucormycosis: A single-center study of 270 patients from North India

Abstract

Purpose: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation. Methods: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs. Results: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively. Conclusion: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.

Collaborative Study of COVID-19 Associated Rhino- Orbital-Cerebral Mucormycosis in Iran (CA-ROCM-IR): A Preliminary Report

“…In concurrence with our study, the most common presenting symptoms reported by a cross-sectional study on 270 CA-ROCM patients and a prospective study on 49 CA-ROCM patients were facial/periorbital pain and swelling 19,22 . A systematic review and meta-analysis on 2,312 proven CAM patients reported headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%), decreased or loss of vision (31%), ptosis (28%), dental pain or loosened teeth (25%), palatal discoloration or ulcers (22%) as common symptoms 13 , which are almost consistent with our study.…”

“…Consistent with other studies 20,22 , ptosis, periorbital edema, periocular pain/tenderness, ophthalmoplegia, and proptosis are common ocular and periocular signs and symptoms among CA-ROCM patients. Of 35 involved eyes in a cross-sectional study, retinal artery occlusion and disc edema were observed in 23% and 11%, respectively 20 .…”

Is orbital wall fracture associated with SARS-CoV-2 ocular surface contamination in asymptomatic COVID-19 patients?

“…Apart from the commonly mentioned rhino-orbital-cerebral mucormycosis [ 16 ], COVID-19-related orbital abscess has been sporadically reported in the literature [ 17 ]. Indeed, approximately 1–6% of OWF (especially those with sinusitis 1–2 weeks pre-trauma or as long as 4–5 weeks post-injury [ 14 , 15 ]) develop orbital cellulitis, and 4% of which extend intracranially, e.g., in the form of cavernous sinus thrombosis, meningitis, or subdural or cerebral empyema [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In our study, there was no orbital cellulitis because patients with underlying rhinosinusitis and/or eye diseases were excluded.…”

“…In our study, there was no orbital cellulitis because patients with underlying rhinosinusitis and/or eye diseases were excluded. However, anaerobic cellulitis resulting from orbital tissue hypoperfusion due to the fracture [ 16 ], or a COVID-prothrombotic event [ 1 , 15 , 17 ] may be developed in COVID-19 patients.…”

Head and neck imaging manifestations in COVID-19: collective experience of 17 months during 2nd wave of the pandemic

“…COVID-19 is well known to result in pulmonary and multiple extra-pulmonary manifestations [ 1 ]. Among the extra-pulmonary manifestations, head and neck involvement, primarily of the sino-nasal, orbital and otic compartments, were increasingly recognized during the second wave of pandemic [ 2 , 3 ].…”