Quiz: A Bubble of Trouble
Test your understanding of this case with 11 questions.
PATIENT DEMOGRAPHICS
62-year-old male
PRESENTING COMPLAINT
Presented with diplopia following stab wounds to the face.
EXAMINATION FINDINGS
Visual Acuity: OD: 6/6. OS: 6/12
Pupils: Left RAPD present, consistent with optic nerve compromise
Fundus: Mild left proptosis, consistent with the volume of orbital air present
INVESTIGATIONS
Frontal facial photograph demonstrating sutured lacerations of the nasal bridge and left inferior periorbital region with left conjunctival injection and chemosis
Formal motility testing demonstrating restricted left ocular movement
Lids elevated during gaze testing demonstrating restricted left ocular motility
Clinical Photography: Demonstrates sutured facial lacerations, left conjunctival injection and chemosis, and restricted ocular motility on formal testing.
Coronal CT demonstrating extensive left orbital emphysema
Sagittal CT demonstrating orbital air tracking with a wound tract extending into the inferior orbit
Axial CT demonstrating left orbital air with medial displacement of the lateral rectus and stretching of the optic nerve
CT Orbits (axial, coronal, and sagittal views): Demonstrates extensive left orbital emphysema (air), with stretching of the optic nerve from the volume of air present. The lateral rectus is displaced medially by the air, and findings are consistent with a wound tract extending into the inferior orbit.