CD56 Negative Extranodal NK/T-cell Lymphoma of the Orbit Mimicking Orbital Cellulitis.

Feb 2013

Pine RR, Clark JD, Sokol JA.

Source

Oculofacial Plastic and Orbital Surgery, KU Eye, University of Kansas , Kansas City, Kansas , USA , and.

Abstract

Introduction: 

To report a case of Extranodal NK/T-cell lymphoma of the orbit mimicking orbital cellulitis. Case Description: A 52-year-old healthy male presented to our institution after 3 months of treatment for sinusitis with antibiotics and steroids. The patient was transferred due to the presence of an "orbital abscess" on CT with orbital signs that not responding to antibiotics. Clinical examination was significant for decreased vision in the affected orbit of 20/50, a trace RAPD OS, elevated IOP of 30 OS, proptosis and grossly decreased motility with diplopia, periorbital edema and chemosis. Dilated funded exam was unremarkable. CT imaging demonstrated a left sided pan-sinusitis, a medial "orbital process" with proptosis and erosion of the cribiform plate. The patient was taken for an emergent orbital exploration for histopathologic diagnosis. Intraorbital and sinus biopsy was consistent with extranodal NK/T-cell lymphoma, with extension into the skull base and left orbital space. The patient was started on radiation therapy followed by chemotherapy. Comments: The authors demonstrate how the acute presentation of an aggressive extranodal NK/T-cell lymphoma can present in a similar fashion as orbital cellulitis. Additionally, the case highlights that a unilateral pansinusitis with involvement of the skull base and orbit is likely due an aggressive malignant process in an immune competent patient.

PubMed

Imaging in infections of the head and neck.

Nov 2012

Hegde AN, Mohan S, Pandya A, Shah GV.

Source

Department of Radiology, Singapore General Hospital, Block 4, Level 1, Outram Rd, Singapore 169608. Electronic address: amogh77@yahoo.co.in.

Abstract

Infections of the head and neck vary in their clinical course and outcome because of the diversity of organs and anatomic compartments involved. Imaging plays a central role in delineating the anatomic extent of the disease process, identifying the infection source, and detecting complications. The utility of imaging to differentiate between a solid phlegmonous mass and an abscess cannot be overemphasized. This review briefly describes and pictorially illustrates the typical imaging findings of some important head and neck infections, such as malignant otitis externa, otomastoiditis bacterial and fungal sinusitis, orbital cellulitis, sialadenitis, cervical lymphadenitis, and deep neck space infections.

Elsevier

A rare case of orbital cellulitis followed by therapeutic(orthodontic) extraction.

Sept 2011

Srinivasa Prasad B, Govardhan T.

Abstract

We report a rare case of orbital cellulitis occurring secondary to a dental infection followed by therapeutic (orthodontic) extraction. A 16 year old female patient presented to the dental office with a left orbital proptosis for the past 4 days. PNS view, CT scan revealed an abscess in relation to medial, lateral superior inferior walls of the orbit associated with naso ethmoidal and left maxillary sinus. Through nasal endoscopy, middle meatus antrostomy and ethmoidectomy was performed for the drainage of pus from the orbit, ethmoid and maxillary sinus under general anesthesia. Immediately regression of orbital swelling was noticed. Eyeball movements improved. Epiphora reduced and proptosis declined. With the advent of higher antibiotics, orbital infection rarely occurs secondary to dental causes except in a very few cases. Complete elimination of pus from orbital cavity, para nasal air sinuses and appropriate antibiotic coverage at the earliest forms the mainstay of treatment. The nasal endoscopic approach with orbital decompression is the most acceptable atrumatic, cosmetic and functional procedure.

NCBI/NIH

MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging.

MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging.

AJNR Am J Neuroradiol. 2008 Oct 8

Kapur R, Sepahdari AR, Mafee MF, Putterman AM, Aakalu V, Wendel LJ, Setabutr P.
Departments of Ophthalmology and Visual Sciences and Radiology, University of Illinois at Chicago, Chicago, Ill; Department of Radiology, University of California, San Diego, Calif; and Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.

BACKGROUND AND PURPOSE: Orbital inflammatory syndrome (OIS) has clinical features that overlap with orbital lymphoid lesions and orbital cellulitis. Prompt diagnosis is needed in all 3 conditions because the management of each one differs greatly. CT and MR imaging, though useful, do not always distinguish among these conditions. The aim of this study was to identify the role of diffusion-weighted imaging (DWI) in differentiating these 3 diagnoses.

MATERIALS AND METHODS: A retrospective analysis of orbital MR imaging was conducted. T1- and T2-weighted and postcontrast images were analyzed. Region-of-interest analysis was performed by using measurements in areas of abnormality seen on conventional MR imaging sequences and measurements of the ipsilateral thalamus for each patient. The DWI signal intensity of the lesion was expressed as a percentage of average thalamic intensity in each patient. Similarly, lesion apparent diffusion coefficients (ADCs) and lesion-thalamus ADC ratios were calculated. Statistical significance was determined by the Kruskal-Wallis test, and post hoc pairwise comparisons, by the Mann-Whitney U test for DWI-intensity ratio, ADC, and ADC ratio.

RESULTS: A significant difference was noted in DWI intensities, ADC, and ADC ratio between OIS, orbital lymphoid lesions, and orbital cellulitis (P < .05). Lymphoid lesions were significantly brighter than OIS, and OIS lesions were significantly brighter than cellulitis. Lymphoid lesions showed lower ADC than OIS and cellulitis. A trend was seen toward lower ADC in OIS than in cellulitis (P = .17).

CONCLUSIONS: DWI may help differentiate OIS from lymphoid lesions and cellulitis and may allow more rapid management.

American Journal of Radiology (Full text article)

Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.

Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.
Ophthalmology. 2007 Feb;114

Chaudhry IA,
Shamsi FA,
Elzaridi E,
Al-Rashed W,
Al-Amri A,
Al-Anezi F,
Arat YO,
Holck DE.

Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. orbitdr@hotmail.com

PURPOSE: To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East.

DESIGN: Noncomparative, interventional, retrospective case series.

PARTICIPANTS: Patients diagnosed with orbital cellulitis.

METHODS: A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study.

MAIN OUTCOME MEASURES: Patient demographics, factors predisposing to orbital cellulitis, and resulting complications.

RESULTS: A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days vs. 9 days in patients with no loss of vision.

CONCLUSIONS: Untreated sinusitis and prior history of orbital trauma were the 2 major causes of orbital cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of orbital cellulitis.

PMID: 17270683 [PubMed - in process]