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Diagnosing An Orbital Abscess Using Ocular POCUS

September 19, 2019


one of the real fun things about getting some
point of care ultrasound skills is that you begin to translate
applications that you have learned to look for new
things. So I have done a lot of point of care ultrasound for endotracheal tube confirmation and ruling out esophageal endotracheal tubes and using that I’ve been able to confirm
a few cases of impacted esophageal food bolises so a novel question with a known
application. Another example of this I had recently
was I managed to diagnose an orbital abscess using ocular ultrasound. I’ve been doing
a lot of ocular ultrasound for optic nerve sheath
diameter and how that might help us in kids with either acute
traumatic brain injury or kids with ventriculoperitoneal shunts who might be obstructed and that’s given me a good sense of what
the retro orbital tissues look like. So I had this five year old boy come to the ER – 24 hours after he’d been
discharged from a hospital. He was in this hospital for 4 days getting IV antibiotics because he had a
sinusitis that was diagnosed on x-ray and on the
same side he had developed a periorbital cellulitis He had one of these big puffy eyes in the
photos that the family showed me but it had just gotten better every day
that he had been in the hospital getting his IV antibiotics. So they were discharged went home he was
fever free but over these 24 hours the mom was saying he just, he’s not looking in all
directions. I will put something on one side of the room and he’ll
look towards it, but when I put it on the other side of the room he turns his
whole head. This five-year-old had been traumatized by
needle pokes and a stay in hospital so it didn’t matter what kind pediatric tricks I tried to pull out my
bag he was not interested in my examination at all I couldn’t tell you anything about his
extra ocular movements and mostly what he did when I came anywhere
close to him was scrounge up his eyes and cry like crazy. So I took my point of care ultrasound machine and with the family helping me out I
managed to do a focused ocular scan and what I was
doing with this is I was trying to interrogate some of the retro orbital fat and see if I could
get any kind have views to suggest that he
might have an abcess or might have orbital cellulitis would he have cobblestoning could be have
discreet collection that I’d be able to see and what we have here is an image of
his right eye on the right side of your screen is the medial side of that
orbit and you can see there’s this dark
stranding within the orbital fat on that side I wasn’t able to get the fullest view but I now had a suspicion the he had an
abscess or a periorbital, sorry an orbital
cellulitis on the medial side his right eye and that let me better focus my next
investigations which were CT absorbed and let me feel justified that the
radiation of the CT was in fact in his best interest the CT confirmed a one by three centimeter
orbital abscess on that side he got drained the same day I actually
saw him come back to the ER for unrelated complaint three days later
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