[Orbital subperiosteal hematoma in child with sickle cell thalassemia. A case report].
Service de radiologie pédiatrique, hôpital d'Enfants de Tunis, place Bab Saadoun, 1007 Tunis Jabbari, Tunisia.Archives de Pédiatrie (Impact Factor: 0.41). 05/2010; 17(8):1174-7.
Sickle cell anemia is the most common hemoglobinopathy worldwide; its musculoskeletal complications consist more often of medullary infarctions involving long bones. Orbital infarction is uncommon. We report on a case of orbital subperiosteal hematoma in a 9-year-old male with a medical history of sickle cell thalassemia.
Article: Nontraumatic orbital hemorrhage[Show abstract] [Hide abstract]
ABSTRACT: Nontraumatic orbital hemorrhage (NTOH) is uncommon. I summarize the published reports of NTOH and offer a classification based on anatomic and etiologic factors. Anatomic patterns of NTOH include diffuse intraorbital hemorrhage, "encysted" hemorrhage (hematic cyst), subperiosteal hemorrhage, hemorrhage in relation to extraocular muscles, and hemorrhage in relation to orbital floor implants. Etiologic factors include vascular malformations and lesions, increased venous pressure, bleeding disorders, infection and inflammation, and neoplastic and nonneoplastic orbital lesions. The majority of NTOH patients can be managed conservatively, but some will have visual compromise and may require operative intervention. Some will suffer permanent visual loss, but a large majority have a good visual outcome.
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ABSTRACT: Orbital complications in sickle cell disease are uncommon, but can be severe enough to result in significant morbidity. We report a 10-year-old boy with sickle cell disease who presented with fever, bilateral eyelid edema, proptosis, and diminished vision with left eye involvement more than the right eye. Investigations revealed anemia, thrombocytopenia, and derangement of coagulation profile consistent with disseminated intravascular coagulopathy, and salmonella species was recovered from blood culture. MRI of the orbits showed bilateral large subperiosteal hematomas. The treatment included intravenous antibiotics, pulse methylprednisolone and bilateral canthotomy with surgical drainage of the hematomas. Postoperative visual assessment revealed complete loss of vision in the left eye with normal vision in right eye. This case highlights the importance of the early evaluation and consideration of surgical intervention in sickle cell disease with this rare complication.
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