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Radiographic Course of Medically Managed Pediatric Orbital Subperiosteal Abscesses.
Journal of Pediatric Ophthalmology and Strabismus
|August 31, 2018
Summary
Subperiosteal orbital abscesses in children often worsen initially before gradually resolving on imaging within 3 weeks. This natural course informs clinical management decisions for pediatric orbital cellulitis.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Radiology
Background:
- Subperiosteal orbital abscesses are a known complication of orbital cellulitis in children.
- Medical management is an option for select cases, but the natural radiographic progression requires further elucidation.
Purpose of the Study:
- To describe the natural radiographic course of subperiosteal orbital abscesses managed non-surgically in pediatric patients.
- To provide data to guide clinical decision-making in managing pediatric orbital cellulitis with subperiosteal empyema.
Main Methods:
- Retrospective case review of pediatric patients diagnosed with orbital cellulitis or subperiosteal abscess between 2008 and 2017.
- Analysis of 15 patients with repeat imaging who did not undergo surgery prior to the second scan.
- Recorded initial and repeat empyema size and clinical course.
Main Results:
- Empyema size increased by an average of 240% within the first 2-3 days.
- Radiographic resolution occurred in 4 cases by day 21, while 9 cases persisted.
- Two cases experienced recurrence months later.
Conclusions:
- Subperiosteal empyema size typically increases for a few days before gradual radiographic resolution over 1-3 weeks.
- Complete radiographic resolution can take up to 21 days.
- Understanding this natural history aids in managing pediatric orbital cellulitis and subperiosteal empyema.
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