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Let's take a look at this patient who had

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symptoms of sinusitis associated with proptosis.

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So this is not too subtle.

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Here we have a post-contrast CT scan,

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as you can see, and the patient has

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opacification of the left maxillary sinus.

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There's soft tissue in the left nasal cavity.

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The ethmoid sinus is opacified.

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Here we may have some element of loss of some

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of the septations of the ethmoid sinus.

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It looks like one large

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air cell here, so some destruction of

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the bony walls of the ethmoid sinus.

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And then we identify a collection of air

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which should not be there outside the sinus.

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In the extraconal soft tissues, we see

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that characteristic medial deviation

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of the left medial rectus muscle.

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And we have this

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inflammatory collection lateral to that muscle.

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And you notice that there is indeed proptosis.

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There's soft tissue swelling around the orbit on the

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right side. Here, on the coronal bone window, we again

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see the air collection as well as the opacification.

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At this point, we could say the ostiomeatal complex

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is completely opacified, and it also involves

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the frontal sinus on the ipsilateral side.

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Frontal sinus involved on the

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contralateral side, but we're very

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concerned about this collection.

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And again, even though there is not a well-defined

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enhancing rim to this collection, we would term

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this a subperiosteal abscess by virtue of the air

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collection, or call it a phlegmon, if you will.

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Here on the coronal with soft tissue windows,

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you get a good sense of the involvement of

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the extraconal fat, the thickening of the

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medial rectus muscle.

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Compare the medial rectus muscle on the left side

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to the medial rectus muscle on the right side.

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So it's myositis, if you will.

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And then we have some soft tissue infiltration

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around the superior oblique muscle.

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Here's the normal superior oblique

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with normal low-density fat.

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Here we have inflammation in the muscle cone.

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And not only that, but as you go back,

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you see that there's some fluffiness around the

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optic nerve sheath complex, certainly as it

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attaches to the back of the globe. And therefore,

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if we look again here, we see that same kind of

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fluffiness along the optic nerve sheath complex.

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There's some haziness to the orbital fat.

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I would call this a patient who has orbital cellulitis,

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as well as a subperiosteal abscess, as well as

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the periorbital cellulitis superficially,

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all secondary to this ethmoid sinusitis.

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At this point, we wanna make sure we're looking and

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seeing no evidence of intracranial complications of it.

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No evidence of extrasinus involvement.

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The periantral fat here looks pretty good.

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Patient does have some adenoidal enlargement on the

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left side, and maybe a little bit of palatine

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tonsil enlargement, so there's probably an element

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of pharyngitis in addition to the sinusitis,

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orbital cellulitis, periorbital cellulitis,

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and subperiosteal abscess on this case.