free-downloads CSEVideos


Medical CASES

Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Feb 15, 2013.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Joined:
    Mar 21, 2011
    Messages:
    9,642
    Likes Received:
    3,296
    Trophy Points:
    16,075
    Gender:
    Male
    Practicing medicine in:
    Egypt

    What is your medical diagnosis ?

    Pedi.JPG
     

    Add Reply
    neo_star likes this.

  2. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    4 possibilities / Differentials


    In preseptal cellulitis (aka periorbital cellulitis), in contrast to orbital cellulitis proptosis and chemosis are absent; visual acuity, pupillary reactions and ocular motility are unimpaired. (Preseptal cellulitis is an infection of the subcutaneous tissues anterior to the orbital septum.)
    Modes of intection
    1. Exogenous infection may result following skin laceration or insect bites.
    2. Extension from local infections such as from anacute hordeolum or acute dacryocystitis.
    3. Endogenous infection may occur by haematogenous spread from remote infection of the middle ear or upper respiratory tract.


    Orbital cellulitis refers to an acute infection of the soft tissues of the orbit behind the orbital septum.
    Orbital cellulitis may or may not progress to a subperiosteal abscess or orbital abscess
    In orbital cellulitis, signs of marked orbital inflammation usually precede visual loss. In orbital apex syndrome (“posterior orbital cellulitis”), the opposite occurs. Patients present with severe unilateral visual loss and ophthalmoplegia, but with minimal orbital inflammation.

    Staphylococcus aureus is the most common infectious microbe, found in 70% of the cases. Streptococcus is the second leading cause.


    Subperiosteal abscessis collection of purulent material between the orbital bony wall and periosteum, most frequently located along the medial orbital wall. Clinically, subperiostealabscess is suspected when clinical features of orbital cellulitis are associated with eccentric proptosis(as opposed to axial proptosis in case of orbital cellulitis); but the diagnosis is confirmed by CT scan

    Orbital abscessis collection of pus within the orbital soft tissue. Clinically it is suspected by signs of severe proptosis, marked chemosis, complete ophthalmoplegia, and pus points below the conjunctiva, but is confirmed by CT scan.

    Or any combination of the above esp. preseptal cellulits + orbital cellulitis


    I think this is primarily a case of preseptal cellulitis aka periorbital cellulitis + / - orbital cellulitis.


    The case of preseptal cellulitis is strong, becos the eyelids are clearly inflamed and not merely congested. Additionally if there was orbital cellulitis, then the proptosis due to intraorbital soft tissue swelling would not have allowed the eyelids to be so tightly shut.
     

    dr mehran, khine and (deleted member) like this.
  3. DALIMEN48

    DALIMEN48 Young Member

    Joined:
    Feb 15, 2013
    Messages:
    3
    Likes Received:
    0
    Trophy Points:
    10
    Practicing medicine in:
    Tunisia
    preseptal cellulitis
     

  4. dupuytren

    dupuytren Bronze Member

    Joined:
    Jan 21, 2012
    Messages:
    650
    Likes Received:
    50
    Trophy Points:
    1,345
    Occupation:
    Medical student at Vita-Salute San Raffaele Univer
    Practicing medicine in:
    Italy
    periorbital cellulitis
     

  5. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

    Joined:
    Jul 28, 2012
    Messages:
    839
    Likes Received:
    38
    Trophy Points:
    1,245
    Gender:
    Male
    Practicing medicine in:
    Czech Republic
    Yep, its periorbital cellulitis.
     

  6. madhubhashini

    madhubhashini Famous Member

    Joined:
    May 1, 2012
    Messages:
    187
    Likes Received:
    0
    Trophy Points:
    390
    Practicing medicine in:
    Sri Lanka
    periorbital cellulitis
     

  7. Rocket Queen

    Rocket Queen Super Moderator

    Joined:
    Mar 29, 2011
    Messages:
    1,098
    Likes Received:
    52
    Trophy Points:
    4,345
    Practicing medicine in:
    Serbia
    periorbital cellulitis
     

  8. lepersan

    lepersan Active member

    Joined:
    Jan 20, 2013
    Messages:
    36
    Likes Received:
    6
    Trophy Points:
    70
    Gender:
    Male
    Occupation:
    resident
    Location:
    paris
    Practicing medicine in:
    France
    I think it a Ethmoiditis (Orbital Subperiosteal Abcess)
     

  9. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    this patient could have an underlying ethmoiditis (independent of preseptal cellulits ) and if not contained, would more likely spread to the orbital space leading to orbital cellulitis and abscess ( in preference to the preseptal space ). But ethmoidal cellulitis in isolation won't give u this picture i.e inflammation of the preseptal space ( indicated by marked inflammation and not just congestion of the eyelids ). In orbital cellulitis, there will be concentric proptosis and in ethmoidal abscess, u will have eccentric proptosis ( even if not marked ). In this challenge the brawny eyelids r tightly shut.

    Dear friend & colleague, pls don't consider this as a rebuttal...it's just a discussion and u have it in u to add a lot of value to this forum. Only by discussing ideas can b xchanged and concepts clarified and those involved will b much smarter and more importantly 'safer' doctors (-:
     

  10. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Joined:
    Mar 21, 2011
    Messages:
    9,642
    Likes Received:
    3,296
    Trophy Points:
    16,075
    Gender:
    Male
    Practicing medicine in:
    Egypt
    Answer : Orbital Cellulitis
     

Share This Page

<