Needle aspiration of a traumatic subperiosteal haematoma of the orbit

Post-Traumatic Subfrontal with Orbital Extradural Hematoma and Proptosis (Unusual Presentation Managed with Needle Aspiration) A Case Report with Review of Literature

Extradural hematoma (EDH) is a common intracranial pathology following motor vehicle accidents, comprising approximately 0.2 to 6% of all head injuries. The association of EDH with subperiosteal intraorbital hematomas is rarely reported. We report a case of a traumatic subfrontal EDH with subperiosteal hematoma (orbital EDH) successfully treated with needle aspiration, demonstrating that in appropriate patients, needle aspiration can result in the resolution of symptoms without an invasive procedure.

Pediatric posttraumatic orbital subperiosteal hematoma

AIM

To report five children with posttraumatic orbital subperiosteal hematoma.

METHODS

In this study, five cases with posttraumatic orbital subperiosteal hematoma were studied and reviewed along with similar cases in a systematic literature review.

RESULTS

The mean age of our patients was 9.40 ± 3.51 years, ranging from 4 to 13 years, and all were male. Mechanisms of injuries were blunt trauma, falling from a building, car accident, and falling from a bicycle. All patients had unilateral involvement. Treatment options included needle aspiration, surgical drainage, and observation for spontaneous resolution. Except for one patient, positive outcomes were achieved.

CONCLUSION

The most common location for posttraumatic orbital subperiosteal hematoma is the superior orbital wall. Traumatic optic neuropathy and permanent visual loss are uncommon. Observation, surgical drainage, and aspiration are common treatment options.

Clinico-radiological features and treatment outcomes in children with traumatic orbital subperiosteal hematoma

PURPOSE

To study the clinical findings, imaging features, and treatment outcomes in children diagnosed with traumatic orbital subperiosteal hematoma (OSpH).

METHODS

The medical records of eligible OSpH children treated either via needle aspiration or open surgical drainage were reviewed retrospectively. Three anatomical factors (inferior globe displacement, superior orbital sulcus fullness, extraocular movements) and two functional parameters (visual acuity, pupillary reactions) were used to determine overall success.

RESULTS

A total of 10 children (mean age, 6.8 years; 8 males) were included. All had a history of blunt trauma, unilateral presentation, inferior globe displacement, fullness of superior orbital sulcus, and raised retrobulbar resistance. Diminution of vision and restricted elevation was noted in 7 children, and 4 had a relative afferent pupillary defect. Computed tomography (CT) revealed superior OSpH in all 10 children and, additionally, orbital wall fracture in 4. Needle aspiration of the OSpH was performed in 8 children; 2 underwent open surgical drainage. At a mean follow-up of 8.5 months, all children showed satisfactory improvement in both anatomical and functional parameters:1 child had a persistent nebulomacular corneal opacity, and 1 had minimal upper eyelid edema.

CONCLUSIONS

A high index of suspicion, appropriate radiology (CT of orbits), and early management through needle aspiration of OSpH may help in early and satisfactory anatomical and functional outcomes.

The role of early office-based needle aspiration in the management of subperiosteal hematoma

Subperiosteal hematoma of the orbit is a rare complication that may occur in different situations. The most common cause is blunt trauma to the head region. The victims are usually young boys and the common site is usually orbital roof. There is no uniform approach in the literature in the management of subperiosteal hematoma. Conservative management has been recommended in cases with intact visual function. If conservative management is planned, complete resorption of hematoma may last several months, and the patients must tolerate diplopia and varying degrees of proptosis in this relatively long period of time. In this study, four boys (12-15 years) were referred to our clinic with a provisional diagnosis of subperiosteal hematoma after blunt trauma no more than 10 days after initial trauma. Although in our patients, no one had compressive optic neuropathy, they underwent hematoma aspiration and nearly 7 ml dark blood was drained. All procedures were performed in an office-based setting without local anesthesia or sedation and the patients tolerated the procedure comfortably and the procedure was uneventful. When there is no indication for orbitotomy in cases of subperiosteal hematoma, early office-based needle aspiration in comparison to follow-up or administration of steroid, is a viable approach because of its feasibility, an office-based treatment that obviates the need for general anesthesia and yields immediate recovery.

Delayed-onset haematoma formation after cochlear implantation

OBJECTIVE

This paper presents our experience on delayed-onset haematoma formation after cochlear implantation, a topic which has not been well discussed in the literature.

METHOD

Retrospective case review study.

RESULTS

Five children who had undergone cochlear implant surgery at 1.5 to 4 years of age (median, 2.5 years) were studied. The haematoma episodes occurred 2-12 years (median, 6 years) after cochlear implantation. Two patients had recurrent episodes. Two of the seven haematoma episodes were managed by needle aspiration alone, four by incision and drainage alone, and one by both needle aspiration and incision and drainage. Other than one patient with coagulopathy, there were no obvious predisposing factors, including trauma.

CONCLUSION

The majority of delayed-onset haematomas occurred without obvious predisposing factors. Needle aspiration can differentiate a haematoma from an abscess or cerebrospinal fluid leakage, and it provides an effective immediate therapeutic solution. However, aseptic techniques are emphasised to minimise the chances of an uncomplicated haematoma converting into a septic one.

Nontraumatic subperiosteal bilateral orbital hemorrhages after mitral valve repair

Nontraumatic subperiosteal orbital hemorrhages (NTSOHs) are rare events, but pose a grave risk of vision loss and must be evaluated carefully for optic nerve compromise. To the author's knowledge, only 2 cases of NTSOH after cardiovascular procedures have been reported. The authors report a unique case of bilateral NTSOH with optic neuropathy that developed after cardiothoracic surgery and reaccumulated after orbitotomy. The case presentation conforms to the tenets of the Declaration of Helsinki and is Health Insurance Portability and Accountability Act compliant. The etiology and management of this uncommon and dangerous entity will be discussed.

Spontaneous subperiosteal hematoma precipitated by anxiety attack

A 60-year-old woman presented with diplopia and left periorbital edema and pressure, which developed during an anxiety attack the previous day. Examination revealed left inferotemporal globe dystopia, periorbital edema, ecchymosis, and limitation in supraduction. Orbital MRI confirmed the diagnosis of a superior subperiosteal orbital hematoma. The patient's signs and symptoms rapidly resolved with administration of oral corticosteroids. The patient remains asymptomatic with complete resolution of orbital signs at 3-month follow-up. Subperiosteal orbital hematoma (SOH) is a rare condition in which blood accumulates between the bony orbit and separated periosteum, and is often due to blunt head trauma. Non-traumatic SOH (NTSOH) is exceedingly rare and usually associated with known coagulopathies or tendency to bleed. However, few cases of spontaneous NTSOH have been reported without any such predisposition and are thought to be caused by sudden elevations in intrathoracic and intracranial venous pressure such as vomiting, coughing, SCUBA diving, weight lifting and labor. We herein describe the presentation, radiography and outcome of a unique case of spontaneous NTSOH following an anxiety attack.

[Orbital subperiotal hematoma associated with extradural hematoma: one case report]

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering.

Clinical features and management of posttraumatic subperiosteal hematoma of the orbit

Traumatic subperiosteal hematoma (SpH) usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

Bilateral orbital haematomas in an anticoagulated patient with severe H1N1 influenza

A previously healthy woman was admitted to the intensive care unit (ICU) with severe H1N1 influenza. She had prolonged hospital stay due to multiple complications of critical illness, including pelvic deep vein thrombosis (DVT), which was treated with subcutaneous enoxaparin. The patient was referred to the ophthalmology service for bilateral proptosis. On examination, she had bilateral tense proptosis, worse on the left side with exposure keratopathy. Laboratory tests showed that she had thrombocytopenia and raised activated partial thromboplastin time (APTT). A CT scan revealed well-circumscribed soft tissue density lesions in the superolateral orbits and was reported as bilateral lacrimal gland enlargement. However, based on a clinical suspicion of subperiosteal hematoma collection, a diagnostic tap was performed. Following aspiration of six mls of dark blood from the left superior orbit, there was a reduction of proptosis with improvement in chemosis and resolution of exposure keratopathy. Enoxaparin is one of several antithrombotic agents which are increasingly being used for DVT prophylaxis in severely compromised patients. Furthermore, ICU patients ventilated for prolonged periods are at risk of developing chemosis and exposure keratopathy. Thus, the clinician should maintain a high index of suspicion in identifying subperiosteal hematomas, when managing such cases. The spontaneous bilateral vision threatening subperiosteal hematoma was probably caused by a combination of enoxaparin therapy and prolonged ventilation.

Late Subperiosteal Hematomata Associated with Craniofacial Surgery

Hematomata are well-recognized complications of surgery. Subperiosteal hematomata occur rarely and have not been well documented after craniofacial surgery. It is possible that craniofacial surgery increases the likelihood of subperiosteal hematomata occurring after minor trauma, even long after surgery, with a risk of subsequent ossification. Over a period of 7 years, 12 patients were identified as having possible subperiosteal hematomata. A number of these patients displayed distinct ossification in the area of the subperiosteal hematoma, resulting in an obvious contour defect. This can be prevented if the patients present early enough and if the hematoma is evacuated. Prompt evacuation of the hematoma is therefore suggested in any case with a history suggestive of a subperiosteal hematoma.

Subperiostales Hämatom der Orbita nach kardiochirurgischem Eingriff

We report on a patient who suffered sudden diplopia after heart surgery. Computed tomography of the orbita revealed a subperiosteal hemorrhage as the underlying cause. We discuss possible mechanisms that may have led to the bleeding as well as therapeutic options.

Diagnosis and Treatment of Orbit Posttraumatic Subperiosteal Hemorrhage in a Child, Associated with a Subdural Intracranial Hemorrhage

We describe a rare case of traumatic subperiosteal orbital hematoma in a child, with intracranial hemorrhagic complication. Subperiosteal hematoma are the more infrequent occurrences among intraorbital hemorrhagic lesions and can be also associated with intracranial extradural hematoma in patients with orbital roof fracture. Here, we describe a case without roof fracture but with a never-before described intracranial subdural hematoma. The patient underwent computed tomography and magnetic resonance imaging, in an acute state, and later, a radiologic diagnosis of percutaneous drainage of the hematoma was mad. MRI was more sensitive and specific in the evaluation of the intracranial and intraorbital complication.