Skip to main content

Advertisement

SpringerLink
Log in

Nontraumatic orbital emergencies: a pictorial essay — CT and MRI features for an imaging findings-based approach

  • Pictorial Essay
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Orbital imaging plays a pivotal role in each hospital with an Ophthalmological Emergency Department. Unenhanced orbital computed tomography (CT) usually represents the first-line tool for the assessment of nontraumatic orbital emergencies, thanks to its quick execution, wide availability, high resolution, and availability of multiplanar reformats/reconstructions. Magnetic resonance imaging (MRI) is an essential tool that allows characterization and a better understanding of the anatomical involvement of different disorders due to its excellent contrast resolution and ability to study the visual pathways, even if, unfortunately, it is not always available in the emergency setting. It represents the first imaging choice in pediatric patients, due to the absence of ionizing radiation. When available, CT and MRI are often used together to diagnose, assess the extent, and provide treatment plans for various orbital nontraumatic emergencies, including infective, inflammatory, vascular, and neoplastic diseases. Familiarity with the imaging appearances of these disorders helps the radiologists to establish the correct diagnosis in the emergency setting, which contributes to timely clinical management. This pictorial essay provides a description of the clinical presentation and imaging findings of nontraumatic orbital emergencies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Cellina M, Floridi C, Panzeri M, Giancarlo O (2018) The role of computed tomography (CT) in predicting diplopia in orbital blowout fractures (BOFs). Emerg Radiol 25:13–19. https://doi.org/10.1007/s10140-017-1551-1

    Article  PubMed  Google Scholar 

  2. LeBedis CA, Sakai O (2008) Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting. Radiographics 28:1741–1753. https://doi.org/10.1148/rg.286085515

    Article  PubMed  Google Scholar 

  3. Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B (2017) Demystifying orbital emergencies: a pictorial review. Radiographics 37:947–962. https://doi.org/10.1148/rg.2017160119

    Article  PubMed  Google Scholar 

  4. Gospe SM, Bhatti MT (2018) Orbital Anatomy. Int Ophthalmol Clin 58:5–23. https://doi.org/10.1097/IIO.0000000000000214

    Article  PubMed  Google Scholar 

  5. Ferreira TA, Saraiva P, Genders SW, Buchem MV, Luyten GPM, Beenakker J-W (2018) CT and MR imaging of orbital inflammation. Neuroradiology 60:1253–1266. https://doi.org/10.1007/s00234-018-2103-4

    Article  PubMed  PubMed Central  Google Scholar 

  6. Eissa L, Abdel Razek AAK, Helmy E (2021) Arterial spin labeling and diffusion-weighted MR imaging: utility in differentiating idiopathic orbital inflammatory pseudotumor from orbital lymphoma. Clin Imaging 71:63–68. https://doi.org/10.1016/j.clinimag.2020.10.057

    Article  PubMed  Google Scholar 

  7. Limone PP, Bianco L, Mellano M, Garino F, Giannoccaro F, Rossi A, Airaldi C, Nassisi D, Gino E, Deandrea M, Oldani B, Ruo Redda MG (2021) Is concomitant treatment with steroids and radiotherapy more favorable than sequential treatment in moderate-to-severe graves orbitopathy? Radiol Med 126:334–342. https://doi.org/10.1007/s11547-020-01244-5

    Article  PubMed  Google Scholar 

  8. de Arcaya AA, Cerezal L, Canga A, Polo JM, Berciano J, Pascual J (1999) Neuroimaging diagnosis of Tolosa-Hunt syndrome: MRI contribution. headache. J Head Face Pain 39:321–325. https://doi.org/10.1046/j.1526-4610.1999.3905321.x

    Article  Google Scholar 

  9. Cellina M, Pirovano M, Ciocca M, Gibelli D, Floridi C, Oliva G (2021) Radiomic analysis of the optic nerve at the first episode of acute optic neuritis: an indicator of optic nerve pathology and a predictor of visual recovery? Radiol Med 126:698–706. https://doi.org/10.1007/s11547-020-01318-4

    Article  PubMed  Google Scholar 

  10. Cellina M, Fetoni V, Ciocca M, Pirovano M, Oliva G (2018) Anti-myelin oligodendrocyte glycoprotein antibodies: magnetic resonance imaging findings in a case series and a literature review. Neuroradiol J 31:69–82. https://doi.org/10.1177/1971400917698856

    Article  PubMed  Google Scholar 

  11. Eustis HS, Mafee MF, Walton C, Mondonca J (1998) MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiol Clin North Am 36:1165–1183. https://doi.org/10.1016/S0033-8389(05)70238-4

    Article  CAS  PubMed  Google Scholar 

  12. Cellina M, Fetoni V, Baron P, Orsi M, Oliva G (2015) Listeria meningoencephalitis in a patient with rheumatoid arthritis on anti–interleukin 6 Receptor Antibody Tocilizumab. JCR J Clin Rheumatol 21:330. https://doi.org/10.1097/RHU.0000000000000287

    Article  PubMed  Google Scholar 

  13. Van Tassel P, Lee Y, Jing B, De Pena C (1989) Mucoceles of the paranasal sinuses: MR imaging with CT correlation. Am J Roentgenol 153:407–412. https://doi.org/10.2214/ajr.153.2.407

    Article  Google Scholar 

  14. Moulin G, Pascal T, Jacquier A, Vidal V, Facon F, Dessi P, Bartoli JM (2003) Imagerie des sinusites chroniques de l’adulte [Radiologic imaging of chronic sinusitis in the adult]. J Radiol 84:901–919

    CAS  PubMed  Google Scholar 

  15. Kohanim S, Daniels AB, Huynh N, Eliott D, Chodosh J (2012) Utility of ocular ultrasonography in diagnosing infectious endophthalmitis in patients with media opacities. Semin Ophthalmol 27:242–245. https://doi.org/10.3109/08820538.2012.711417

    Article  PubMed  Google Scholar 

  16. Bhardwaj G, Chowdhury V, Jacobs MB, Moran KT, Martin FJ, Coroneo MT (2010) A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma. Ophthalmology 117:983-992.e17. https://doi.org/10.1016/j.ophtha.2009.09.040

    Article  PubMed  Google Scholar 

  17. Conart J-B, Berrod J-P (2016) Hémorragies du vitré non traumatiques. J Fr Ophtalmol 39:219–225. https://doi.org/10.1016/j.jfo.2015.11.001

    Article  PubMed  Google Scholar 

  18. Halbach V, Hieshima G, Higashida R, Reicher M (1987) Carotid cavernous fistulae: indications for urgent treatment. Am J Roentgenol 149:587–593. https://doi.org/10.2214/ajr.149.3.587

    Article  CAS  Google Scholar 

  19. Tailor TD, Gupta D, Dalley RW, Keene CD, Anzai Y (2013) Orbital neoplasms in adults: clinical, radiologic, and pathologic review. Radiographics 33:1739–1758. https://doi.org/10.1148/rg.336135502

    Article  PubMed  Google Scholar 

  20. Nagesh C, Rao R, Hiremath S, Honavar S (2021) Magnetic resonance imaging of the orbit, part 2: characterization of orbital pathologies. Indian J Ophthalmol 69:2585. https://doi.org/10.4103/ijo.IJO_904_21

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milano, Milan, Italy

    Michaela Cellina & Giancarlo Oliva

  2. Postgraduation School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Maurizio Cè, Giovanni Irmici, Sara Marziali, Natallia Khenkina & Gianpaolo Carrafiello

  3. Radiology Department, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy

    Carlo Martinenghi

  4. Radiology Department, Policlinico Di Milano Ospedale Maggiore , Fondazione IRCCS Ca Granda Via Francesco Sforza 35, 20122, Milan, Italy

    Anna Maria Ierardi & Gianpaolo Carrafiello

  5. Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy

    Gianpaolo Carrafiello

Authors
  1. Michaela Cellina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maurizio Cè
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Irmici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlo Martinenghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara Marziali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Natallia Khenkina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anna Maria Ierardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giancarlo Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gianpaolo Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michaela Cellina.

Ethics declarations

Ethics approval and consent to participate

The images included in this educational article belong to an IRB study approved on February 19, 2019; Experimentation Register Number 2018/ST/191, approved by the Ethics Committee Sacco Area 1, Milan, Italy. The patients provided written consent for the use of their anonymized images.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cellina, M., Cè, M., Irmici, G. et al. Nontraumatic orbital emergencies: a pictorial essay — CT and MRI features for an imaging findings-based approach. Emerg Radiol 29, 769–780 (2022). https://doi.org/10.1007/s10140-022-02047-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-022-02047-z

Keywords

Search

Navigation