Findings
- Extensive fat stranding and soft tissue edema throughout the left face extending into the left parapharyngeal space and inferior periorbital region
- Infiltration of the retroantral fat and infrazygomatic masticator space
- Inflammatory soft tissue extends into the inferolateral extraconal left orbit with slight proptosis
- Enlargement and hyperenhancement of the left sublingual gland
- Asymmetric hypoattenuation of the posterior aspect of the left superior ophthalmic vein and of the left cavernous sinus
- Extensive dental disease with multiple missing teeth, caries, and periapical lucencies, but no discrete subperiosteal abscess
- Inflammatory mucosal thickening throughout bilateral ethmoid air cells and involving the maxillary sinuses and left sphenoid sinus
- Extensive streak artifact related to multiple dental fillings
Diagnosis
Facial cellulitis
Orbital cellulitis
Cavernous sinus thrombosis
Sample Report
Extensive left facial cellulitis without abscess extending into the left masticator and parapharyngeal spaces as well as into the left inferior periorbital and inferolateral left retrobulbar extraconal fat, consistent with preseptal and postseptal orbital cellulitis. Slight associated left proptosis.
Mild mass effect on the oropharyngeal airway, which remains patent. No retropharyngeal edema.
Advanced dental disease including multiple periapical lucencies, which could be the source for facial cellulitis, although no discrete subperiosteal abscess is identified. Alternatively, given paranasal sinus mucosal thickening and infiltration of the left retroantral fat, an invasive sinus infection is in the differential.
Asymmetric poor opacification of the left superior ophthalmic vein and left cavernous sinus, concerning for thrombosis. MRI of the brain and orbits with and without contrast is recommended for further evaluation.
Likely reactive sialadenitis involving the left sublingual gland.
Discussion