Document Detail

Paediatric Post-septal and Pre-septal Cellulitis: 10-year Experience at a Tertiary-level Children's Hospital.
MedLine Citation:
PMID:  24288398     Owner:  NLM     Status:  Publisher    
Aims:To assess the incidence and complications of pre-septal (Pre-SC) and post-septal cellulitis (Post-SC) over 10 years. Pre-SC and Post-SC are also known as peri-orbital and orbital cellulitis respectively.Methods:Retrospective analysis of CT scans. Data included presence of Pre-SC and Post-SC, paranasal-sinus disease (PNS) and complications.Results:Among 125 patients scanned for these suspected diagnoses, 67 had both Pre-SC and Post-SC, 37 had Pre-SC and 4 had Post-SC; there were 17 normal scans. 110 had PNS. 68/71 (96%) patients with Post-SC had PNS. Post-SC complications included orbital and/or sub-periosteal abscess (50/71: 30 medial orbital, 10 supero-medial, 3 lateral, 2 antero-medial, 2 infero-medial, 1 superior and 1 antero-superior), cavernous sinus thrombosis (CST)(1), superior ophthalmic vein (SOV) thrombosis (4) and subdural frontal empyema (2); 1 patient had SOV and cavernous sinus thrombosis and subdural empyema.Conclusions:71/125 (57%) had Post-SC. 50/125 (40%) patients imaged for Pre-SC/Post-SC had orbital abscess, of which 44/50 (88%) involved the medial orbit. Patients can develop solely superior or inferior abscesses that are difficult to identify by axial imaging alone, hence coronal reformatted imaging is essential. 5/125 (4%) patients developed major complications (SOV/CST/empyema), hence imaging review of the head and cavernous sinus region is essential. A diagnosis of Post-SC on CT should alert the radiologist because this diagnosis can be associated with an increased incidence (5/71, 7%) of complications.Advances in knowledge:We recommend that all patients with a suspected diagnosis of Post-SC should undergo CT scan (post-contrast orbits and post-contrast head, with multi-planar reformats and a careful review of the SOV and the cavernous sinus). Particular attention should be paid to exclude intracranial complications including subdural empyema and cerebral abscess. As soon as a diagnosis of Post-SC is made, in addition to informing the referring clinical team, urgent opinion should be sought from ENT, Neurology and Ophthalmology with a view to urgent drainage of the paranasal sinuses.
Anup Mathew; Emma Craig; Reham Al-Mahmoud; Ruth Batty; Ashok Raghavan; Santosh Mordekar; Jonathan Chan; Daniel J A Connolly
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-28
Journal Detail:
Title:  The British journal of radiology     Volume:  -     ISSN:  1748-880X     ISO Abbreviation:  Br J Radiol     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0373125     Medline TA:  Br J Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Radiology, Royal Hallamshire Hospital, Sheffield.
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