超声诊断儿童眼眶横纹肌肉瘤并复发1例(附文献复习)

目的：探讨儿童眼眶横纹肌肉瘤超声声像图特点。方法：回顾性分析1例儿童眼眶横纹肌肉瘤及复发的临床资料并复习相关文献。结果：患者女岁6。发现右眼肿物半月余。入院术前超声检查：右眼眶近鼻侧探及大小约3.0cm×1.5cm的实性低回声团块边界尚清,欠规则回声不均匀,右眼球受压向外移位,双眼球内未见明显异常回声。CDFI:团块内探及丰富血流信号,PW可探及低速高阻动脉频谱,PSV:30cm/s,RI:0.8。诊断意见：右眼眶近鼻侧实性肿块考虑横纹肌肉瘤可能性大,泪腺多形性腺瘤(恶变）待排。患儿全麻下行右眼眶肿瘤摘除术,术后病理：(右眼肿物)恶性肿瘤,符合横纹肌肉瘤。结论：儿童眼眶横纹肌肉瘤较少见,其超声表现具有一定的特征性,掌握这些特征有助于超声医师对此病的诊断。     

Transorbital penetrating brain injury by branchlet: a rare case

Penetrating injury of the brain and skull is uncommon, representing about 0.4% of head injuries. With advances in radiological techniques such as high-resolution and reconstruction computed tomography (CT), assessment of injuries is more accurate and easier. In this article, we report the case of a 46-year-old man presenting with head injury after a branchlet had penetrated through the right orbit into the brain. CT scan of the brain revealed diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and mild obstructive hydrocephalus. CT scan of the brain with reconstruction revealed that the branchlet tip penetrated through the medial aspect of the right orbit to the parasellar region. CT scan of the brain with contrast showed gradual tapering of the right proximal internal carotid artery with total occlusion after the carotid bulb. Advance radiological examinations, such as three-dimensional CT, are required to obtain the correct emergent diagnosis and treatment of such injuries.     

甲状腺相关性眼病行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化

目的初步观察甲状腺相关性眼病(TAO)行内镜下内侧壁眶减压联合脂肪减压术后眼眶各容积参数的变化。方法回顾分析2014年9月-2015年8月于温州医科大学附属眼视光医院由于眼球突出影响外观而行内镜下内侧壁眶减压联合脂肪减压术的TAO患者1 1例(20眼),所有患者确诊为非组织活动期至少6个月,均因眼球突出影响外观而行手术治疗。所有患者术前和术后第3个月行高分辨率CT(HRCT)。运用眼眶CT结合计算机辅助测量软件测量眼球突出度,分析TAO手术前后眼眶各容积参数变化情况,并分析与眼球回退值之间的关系。结果术后眼球突出度较术前有明显降低;手术后内直肌容积(MMV)、球后脂肪容积(FV)、眼眶容积(OV)较术前有增加;手术前后眼外肌容积的变化值(?MV)与眼球回退值呈负性相关,眼眶容积变化值(?OV)与眼球回退值也呈负性相关。结论术后3个月内直肌的增粗,可能与手术干扰、术中去除内侧壁有关。眼外肌体积变化和眼眶容积变化与眼球突出度回退之间存在显著的负相关性。     

Chronic paroxysmal hemicrania: orbital phlebography and steroid treatment

A 62-year-old man with ankylosing spondylitis and with a 3-year history of chronic paroxysmal hemicrania is presented. Because of his ankylosing spondylitis naproxen was prescribed; this decreased the attacks of headache to about 50%. However, treatment with indomethacin and steroids eliminated the attacks completely, the former drug in 24 h but only when the drug was taken; the latter drug was completely effective after a week but with an effect that lasted half a year after the medication was stopped. Orbital phlebography showed changes similar to those previously observed in patients with Tolosa-Hunt syndrome and cluster headache. Venous vasculitis thus seems to be associated with all three disorders and may be a factor of etiologic significance.     

PSEUDOTUMOUR OF THE ORBIT: BILATERAL METACHRONOUS PRESENTATION

SUMMARY A case is presented of a pseudotumour that developed in the left orbit 4 years after surgery and histological confirmation of a pseudotumour in the right orbit. There was no evidence of any thyroid pathology.     

Frontoethmoid sinus osteoma as a cause of subperiosteal orbital abscess

A 65-year-old woman presented with severe periorbital pain and swelling of the left eye, with complete ptosis, proptosis, and conjunctival chemosis. The eye was in a hypotropic position, and activity in the left superior rectus was inadequate. A firm, elastic, 2-cm mass was palpated near the superior orbital rim. Computed tomography revealed a subperiosteal abscess (SPA) at the superior portion of the orbit and a large frontoethmoidal sinus osteoma. After the SPA had been surgically drained and the osteoma completely removed, the patient recovered, with resolution of proptosis, ptosis, and motility limitations. Osteomas of the paranasal sinuses are usually asymptomatic and rarely cause SPA and orbital cellulitis. Therefore, osteoma cases must be closely followed to ensure that early diagnosis and treatment of SPA are successful in preventing severe visual loss and rescuing the patient’s vision.     

Orbital Compartment Syndrome and Irreversible Blindness Related to Orbital Varix Thrombosis: A Case Report

BackgroundOrbital compartment syndrome (OCS) is an ocular emergency that can severely threaten the visual potential. The most common etiologies include facial trauma-related orbital wall fractures and postoperative bleeding within the orbit. Nontraumatic cases were also reported sporadically, although they are rare. The orbital volume limits the compliance to expand when space-occupying lesions develop. Both direct compression of the optic nerve and depleted perfusion from elevated intraorbital pressure subsequently lead to ischemic optic neuropathy and vision loss.Case ReportA 74-year-old man experienced headache, bulging left eye, dull pain, vision loss, nausea, and vomiting within 1 day. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass extending from the orbital apex and connected with the ophthalmic vein. Lateral canthotomy and cantholysis were performed at bedside for emergent orbital decompression. The proptosis and pain relieved after surgery, but visual loss remained irreversible. Surgical exploration was conducted and pathology proved the diagnosis of varix of the ophthalmic vein with thrombosis.Why Should an Emergency Physician Be Aware of This?Clinicians should be aware of the presentation of OCS and perform timely orbital decompression, which could reverse visual impairment. These patients might also benefit from immediate consultants with ophthalmologists and radiologists.     

SUNCT may be Another Manifestation of Orbital Venous Vasculitis

A patient with more than 20 years of SUNCT, i.e., long lasting periods with frequent attacks of intense orbital pain with a duration of about one minute, associated with ipsilateral conjunctival injection, lacrimation, rhinorrhea and facial sweating is described. Some attacks were possibly related to increased cerebral blood flow but could also be triggered from the oral area. Orbital phlebography showed pathologic changes on the side of the pain, changes which were normalized when these attacks ceased to appear. Due to these findings in conjunction with serum evidence of inflammation, associated systemic symptoms and susceptibility to steroids and azathioprine, venous vasculitis is suggested to be the cause of SUNCT in this patient. Carbamazepine and sumatriptan decreased the frequency, intensity and duration of attacks, although not completely.     

Low Flow Dural Arteriovenous Shunt: Another Cause of "Sinister" Tolosa-Hunt Syndrome

SYNOPSIS
A 73-year-old man developed acute, painful, ophthalmoplegia. The pain improved with oral steroids and a diagnosis of Tolosa-Hunt syndrome was made. Review of his angiogram revealed a low flow dural arteriovenous shunt that drained posteriorly. Dural arteriovenous shunts may thus be another cause of "sinister" Tolosa-Hunt syndrome.     

Review article: Maxillofacial emergencies: Maxillofacial trauma

Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non‐specialist management of traumatic injuries of the orbit and facial skeleton.     

An unusual cause of amblyopia ex anisometropia

The case history is reported of an infant with a capillary haemangioma in the superior temporal quadrant of the anterior right orbit. Radiotherapy was not performed in view of the well-known tendency of these tumours to involute. Constant pressure on the globe led to marked oblique astigmatism of the eye with consequent amblyopia, in spite of complete regression of the lesion. The tendency of such tumours to regress must be weighed against possible irreversible functional impairment when a decision is made as regards treatment of neonatal haemangiomas in the region of the orbit.     

Orbital pseudotumour presenting as orbital cellulitis

A 33-year-old woman presented to a community emergency department with a 4-day history of monocular orbital pain, photophobia and pain on extraocular movement. Findings included chemosis, conjunctival injection and restricted extraocular movements causing strabismus. She was diagnosed with orbital cellulitis during her initial emergency department visit and treated with intravenous antibiotics. On her second ED visit later the same day, a diagnosis of orbital pseudotumour was made after computed tomography revealed inflammation of the sclera, optic nerve, muscle and adipose tissue within the orbit. Antibiotics were discontinued and tapering steroids were initiated, with prompt resolution of symptoms.     

T-cell lymphoma of the orbit

In a 52-year-old man with drooping of the right upper eyelid and a palpable mass in the superior temporal quadrant of the right orbit, a biopsy specimen revealed diffuse mixed-type lymphoma with immunostaining evidence of a helper T-cell phenotype. No other foci of lymphoma were found. The orbital lesion was treated with irradiation (total dose, 4,200 cGy administered in 20 treatments). At 4 1/2 years after treatment, the patient had had no recurrence.     

Traumatic pneumomediastinum caused by isolated blunt facial trauma: a case report

Traumatic pneumomediastinum is most often identified as an incidental finding in the setting of blunt or penetrating neck, chest, or abdominal trauma. There are only a few cases in the medical literature of a pneumomediastinum following isolated facial trauma. We present a patient who sustained fractures of the lateral and anterior walls of the right maxillary sinus, floor of the right orbit, and right zygomatic arch. Subcutaneous emphysema overlaid the right facial region and extended to the left side of the neck and into the mediastinum. We describe this unusual complication with respect to the anatomic relations of the facial and cervical fascial planes and spaces with the mediastinum.     

眼眶淋巴瘤的CT诊断

目的：探讨眼眶淋巴瘤的CT表现，提高对其诊断鉴别能力。方法：回顾性分析经手术病理证实的12例眼眶淋巴瘤的CT表现，并作文献复习。结果：12例淋巴瘤中仅1例为霍奇金淋巴瘤，病变位于右侧眼眶肌锥内间隙。11例为非霍奇金淋巴瘤，双侧眼眶发病1例，其余为单侧。12例中局限型7例，病变局限于眼球周围，弥漫型5例，表现为肌锥内外间隙弥漫软组织影，沿眶锥“铸形”生长。结论：淋巴瘤的CT表现具有一定的特征性，即眼眶内软组织包绕眼球生长，眼环无增厚及凹陷，是提示淋巴瘤的重要线索。但最后的诊断有赖于病理活检及免疫组化。     

Anabolic androgenic steroids and a stroke in an athlete: case report

Use of anabolic androgenic steroids among athletes has grown at an alarming rate in recent years, despite the knowledge that their use has resulted in such side effects as severe depression of high-density lipoprotein levels, increased low-density lipoprotein/cholesterol levels, and hepatocellular carcinoma. We report here the case of a 34-year-old man whose hobby was body building, in the course of which he had been taking various anabolic androgenic agents for four years. Seventeen days before a scheduled body physique contest, he developed an acute right hemiparesis and experienced difficulty in speaking. In the emergency room he developed a simple partial seizure activity; an electroencephalogram showed abnormal slowing suggestive of left hemispheric structural lesion. After rehabilitation, he was able to ambulate independently; he had mild motor weakness in the right upper extremity with no sensory changes at discharge. Physicians working with athletes who use anabolic androgenic steroids should warn them of the risk of stroke.     

Topical ocular drug delivery to inner ear disease and sinusitis

Oral steroids are the main therapy for sensorineural deafness. We present the rare case of a patient whose hearing loss associated with inflammation of the inner ear and chronic sinusitis were improved with topical steroid therapy. A 68-year-old male presented with scleritis in the left eye, inflammation of the inner ear and chronic sinusitis. He received oral prednisolone 10 mg/d. However, the oral prednisolone was discontinued due to severe side effects. Topical administration of 0.1% betamethasone sodium phosphate improved the scleritis and incidentally also relieved his symptoms of recurrent otitis and sinusitis after several days. Audiometry revealed recovered acoustic sensation in the right ear, from 50 dB to 20 dB, and in the left ear from 70 to 35 dB with 1,000 Hz. Topical ocular drug delivery of steroids may be effective for inner ear disease and sinusitis in patients with systemic side effects to oral steroids.     

Infarction of the orbit and paranasal sinuses in sickle cell disease

We have reported the case of a 19-year-old black man with sickle cell disease who had swelling over the right frontal and periorbital areas. Plain roentgenograms and CT scans were consistent with frontal sinus disease. At trephination, however, sterile liquescent blood clot was found in the frontal sinus. Awareness of the orbital apex syndrome and infarction of the orbit and sinuses in patients with sickle cell disease is necessary to prevent misdiagnosis of these conditions as suppurative sinusitis.     

A Posttraumatic Dilated,Proptotic Eye Does Not Always Need a Lateral Canthotomy! A Review of Superior Orbital Fissure Syndrome for Emergency Physicians

BackgroundSuperior orbital fissure syndrome (SOFS) is a rare constellation of findings consisting of ophthalmoplegia, ptosis, a fixed dilated pupil, forehead anesthesia, and loss of the corneal reflex. This syndrome, though rare, is most often encountered in trauma with individuals sustaining a facial fracture.Case ReportWe present a case of a young woman who was diagnosed with SOFS after a fall in her house, hitting her face on a nightstand. Treatment consisted of high-dose i.v. steroids followed by a taper with close follow-up in the Ophthalmology clinic. We provide a brief review of SOFS, including treatment considerations and follow-up.Why Should an Emergency Physician Be Aware of This?SOFS can be easily overlooked in an individual presenting to the emergency department after facial trauma with proptosis. However, a thorough examination of the eye, visual acuity, and intraocular pressure will focus the physician on SOFS rather than the need for immediate decompression via lateral canthotomy. This report describes a traumatic cause of SOFS, the pathophysiology and treatment, and summarizes existing literature.     

Recurrent Tolosa-Hunt syndrome

Twenty consecutive patients with recurrent Tolosa-Hunt syndrome were studied. One had a parent who suffered from recurrent Tolosa-Hunt syndrome. Thirty-three percent of the patients had also recurrent periods of weeks to months of unilateral periorbital pain without ophthalmoplegia. One patient had cluster headache before the Tolosa-Hunt syndrome started. Some patients had involvement of cranial nerves outside the cavernous sinus region during Tolosa-Hunt syndrome and also between episodes. The same systemic symptoms, i.e. back pain, cold feet, arthralgia, gut problems, varices, vertigo, chronic fatigue, thrombophlebitis, memory deficiency and signs of inflammation in serum, occurred in Tolosa-Hunt syndrome as earlier found in patients with orbital venous vasculitis. Seventy-three percent of the patients had pathologic orbital phlebograms. All patients treated with steroids reacted promptly; four who developed chronic pain syndromes were treated satisfactorily with azathioprine.