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Paediatric post-septal and pre-septal cellulitis: 10 years' experience at a tertiary-level children's hospital

A V Mathew1, E Craig, R Al-Mahmoud

  • 1Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK.

The British Journal of Radiology
|November 30, 2013
PubMed

Insights

Orbital cellulitis (post-septal cellulitis) is common, often linked to sinus disease, and carries a risk of serious complications. CT imaging, including coronal views and head scans, is crucial for diagnosis and management.

Area of Science:

  • Ophthalmology
  • Radiology
  • Infectious Diseases

Background:

  • Pre-septal cellulitis (pre-SC) and post-septal cellulitis (post-SC), also known as periorbital and orbital cellulitis, are common conditions requiring accurate diagnosis.
  • Paranasal sinus disease (PNS) is frequently associated with pre-SC and post-SC, increasing the risk of complications.

Purpose of the Study:

  • To determine the incidence and complication rates of pre-SC and post-SC over a 10-year period.
  • To evaluate the diagnostic utility of CT scans in identifying pre-SC, post-SC, associated PNS, and complications.

Main Methods:

  • Retrospective analysis of CT scans from 125 patients suspected of having pre-SC or post-SC.
  • Data collected included the presence of pre-SC and post-SC, PNS, and any identified complications.
  • CT scans involved post-contrast orbits and head with multiplanar reformats, focusing on the superior ophthalmic vein (SOV) and cavernous sinus.

Main Results:

  • Of 125 patients, 71 (57%) had post-SC, and 104 (83%) had PNS.
  • Orbital abscesses occurred in 50 patients (40%), predominantly in the medial orbit (88%).
  • Serious complications, including superior ophthalmic vein (SOV) thrombosis, cavernous sinus thrombosis (CST), and subdural empyema, were observed in 5 patients (7%).

Conclusions:

  • Post-SC is frequently associated with PNS and carries a significant risk of orbital abscess and major intracranial complications.
  • CT imaging with coronal reformats is essential for detecting orbital abscesses, especially those in the superior or inferior orbits.
  • Prompt CT evaluation of the orbits, head, and cavernous sinus is recommended for suspected post-SC to identify potential intracranial complications and guide urgent multidisciplinary management.
Abstract

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