WWWTP #10 Answer…

September 22, 2013

WWWTP


This patient came in with trauma to the face after an altercation, here was his head CT:

WWWTP 10

The patient’s left eye is somewhat proptotic in comparison to the right and he has high density fluid consistent with blood in the retrobulbar space.  This is a retrobulbar hemorrhage.  Turns out clinically he had a proptotic eye, intraocular pressures were 27 and he was having difficulty seeing.  After a lateral canthotomy and cantholysis his vision returned, his pressures dropped to the low 20s.  Here is the rest of his CT imaging:

WWWTP 10.1 WWWTP 10.2 WWWTP 10.3

What is even more interesting about this patient is that he had a inferior orbital wall blowout fracture.  The retrobulbar space should be communicating with the maxillary sinus (as you can see there is a lot of blood in the sinus as well) and orbital compartment syndrome usually doesn’t occur with these type of fractures. 

Image Contributor:  Nathan Parker, MD

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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