Imaging

Periorbital Cellulitis

Preliminary Diagnosis: Periorbital Cellulitis

I. What imaging technique is first-line for this diagnosis?

  • CT with contrast of the brain and orbits.

II. Describe the advantages and disadvantages of this technique for diagnosis of periorbital cellulitis.

Advantages

  • Relatively inexpensive and fast imaging modality

  • Better able to characterize the periorbital inflammatory process andthe adjacent osseous structures compared with MR imaging.

  • Able to localize and differentiate the inflammatory process from the surrounding globe, soft tissues, vessels.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less adept at detailing any early intracranial extension of disease (ie, epidural extension) when compared with companion MR imaging

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • Contrasted MR of the brain and orbits

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of periorbital cellulitis.

MRI with contrast of the brain and orbits

Advantages

  • Able to detect subtle adjacent osseous edema and post-contrast enhancement in patients with early associated osteomyelitis

  • Does not expose patients to ionizing radiation

  • More sensitive and specific in detecting secondary abscess development

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

MRI with contrast of the Brain and Orbits

  • Contraindicated in patients with non–MR-compatible hardware

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