Ultrasound in pediatric orbital cellulitis

Abstract

Orbital cellulitis is an infrequent but serious complication of sinus infections in children, as was the case of a 7-year-old who presented to the emergency room with ultrasound signs of preseptal cellulitis. Despite a well conducted antibiotic treatment a control ultrasound demonstrated associated signs of retro-septal extension. This case brings to light the essential role of ultrasound in suspected cellulitis, as a mean to differentiate between preseptal cellulitis and retroseptal (orbital) cellulitis. In the paediatric population ultrasound should be the first intention exam to diagnose the extension of the illness, and help guide the management and follow-up of the patients.

Varicella mimicking complications of acute rhinosinusitis in an infant

“…While a hyperechoid infiltration of the soft tissue and hyperaemia on Doppler examination is typical for preseptal cellulitis, postseptal cellulitis presents as hyperechoid swelling of the intraorbital fat. This might be accompanied by a subperiostal abscess in roughly 50% of the cases 23. If intracranial involvement is suspected, diagnosis and extension have to be verified using CT or MRI 24…”

Orbital Mass Identified With Point-of-Care Ultrasound in a Child Presenting With Eyelid Swelling

“…[3][4][5] Although there is growing evidence of the value of ocular POCUS in identifying signs of increased intracranial pressure by measuring the optic disc elevation 6 and optic nerve sheath diameter, 7,8 other uses have been reported ranging from identifying intraocular pathology such as retinal/ vitreous pathology 5 and lens dislocation to assessing extraocular structures while evaluating for preseptal or orbital cellulitis. 9,10 Ocular POCUS can be especially helpful in low-resource setting to identify patients who will benefit from transfer to a higher level of care.…”

Diagnosis of Endophthalmitis and Orbital Abscess by Ultrasound: A Case Report

“…8,9 Ultrasonographic findings of orbital cellulitis include hyperechoic inflammatory intraconal fat, heterogenous collection of intraorbital material with mixed echogenicity (hyperechoic and hypoechoic), and extraocular muscle edema and/or displacement. 4,[10][11][12] Orbital abscess typically appears as an anechoic to hypoechoic fluid collection, but as with soft tissue abscesses elsewhere in the body, they can also appear isoechoic and contain hyperechoic debris. 4,[10][11][12] The diagnostic accuracy of ultrasound of these findings of orbital cellulitis and abscess has not been well established, but small non-randomized studies suggest ocular ultrasound has a potential for high diagnostic accuracy.…”

“…4,[10][11][12] Orbital abscess typically appears as an anechoic to hypoechoic fluid collection, but as with soft tissue abscesses elsewhere in the body, they can also appear isoechoic and contain hyperechoic debris. 4,[10][11][12] The diagnostic accuracy of ultrasound of these findings of orbital cellulitis and abscess has not been well established, but small non-randomized studies suggest ocular ultrasound has a potential for high diagnostic accuracy. 13,14 Computed tomography is more sensitive for diagnosing orbital abscess than ultrasound and will assist with operative planning.…”