Usmani Eiman, Shapira Yinon, Patel Sandy, Psaltis Alkis J, Selva Dinesh
Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia.
Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia.
Int J Surg Case Rep. 2023 Mar;104:107954. doi: 10.1016/j.ijscr.2023.107954. Epub 2023 Feb 28.
We report a case of spontaneous subperiosteal orbital hematoma many years after endoscopic sinonasal resection of malignancy.
A 50-year-old female with a six-year history of endoscopic sinonasal resection of a poorly differentiated neuroendocrine tumor presented with two days of worsening frontal headache and left periocular swelling. A subperiosteal abscess was initially suspected on CT; however, MRI sequences revealed changes consistent with the diagnosis of hematoma. A conservative approach was justified based on the clinico-radiologic features. Progressive clinical resolution was noted over three weeks. Two monthly follow-up MRI revealed resolution of the orbital findings with no features to indicate recurrence of malignancy.
Subperiosteal pathologies can be clinically challenging to differentiate. Differing radiodensities on CT may help differentiate between them but is not always reliable. MRI is more sensitive and is the preferred imaging modality.
Spontaneous orbital hematomas are self-resolving, and surgical exploration may be avoided in the absence of complications. Therefore, it is beneficial to recognize it as a potential late complication of extensive endoscopic endonasal surgery. Characteristic features on MRI can aid diagnosis.
我们报告一例恶性肿瘤经鼻内镜鼻窦切除术后多年出现的自发性骨膜下眼眶血肿病例。
一名50岁女性，6年前因低分化神经内分泌肿瘤接受经鼻内镜鼻窦切除术，现出现前额头痛加重和左眼周肿胀2天。CT最初怀疑为骨膜下脓肿；然而，磁共振成像（MRI）序列显示的变化符合血肿的诊断。基于临床影像学特征，采取保守治疗方法是合理的。三周内临床症状逐渐缓解。两次每月的随访MRI显示眼眶病变消退，无恶性肿瘤复发迹象。
骨膜下病变在临床上鉴别具有挑战性。CT上不同的放射密度可能有助于鉴别，但并不总是可靠的。MRI更敏感，是首选的成像方式。
自发性眼眶血肿可自行消退，无并发症时可避免手术探查。因此，将其视为广泛经鼻内镜鼻内手术潜在的晚期并发症是有益的。MRI的特征性表现有助于诊断。
