Imaging

Orbital Cellulitis

Preliminary Diagnosis: Orbital Cellulitis

I. What imaging technique is first-line for this diagnosis?

  • Contrasted CT of the brain and orbits.

II. Describe the advantages and disadvantages of this technique for diagnosis of orbital cellulitis.

Advantages

  • Relatively inexpensive and fast imaging modality

  • Better able to detail any associated osseous abnormality than other imaging modalities

Disadvantages

  • Exposes a patient to ionizing radiation

  • Less exquisite detail of the adjacent soft tissues including the orbit, optic nerves, extraocular muscles, and lacrimal glands

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

  • Relative contraindication in patients with allergy to contrast

  • Relative contraindication in patients with renal failure

IV. What alternative imaging techniques are available?

  • Contrasted MR of the brain and orbits.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of orbital cellulitis.

Contrasted MR of the Brain and Orbits

Advantages

  • Offers exquisite detail of the adjacent soft tissues and better characterizes and details intracranial extension

  • Does not expose the patient to ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Less adept at detailing any associated osseous involvement

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MR of the Brain and Orbits

  • Contraindicated in patients with non–MR-compatible hardware

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