Lacrimal gland abscess presenting with preseptal cellulitis depicted on CT
© Ginat et al. 2016
Received: 15 April 2015
Accepted: 7 December 2015
Published: 12 January 2016
Pyogenic lacrimal gland abscesses are uncommon and thus may not be immediately clinically recognized without a high index of suspicion.
We present two patients with preseptal cellulitis and characteristic low-attenuation fluid collections in the lacrimal glands demonstrated on computed tomography (CT).
Lacrimal gland abscesses should be considered when dacryoadenitis is refractory to medical treatment. Indeed, these cases highlight the value of prompt recognition of lacrimal abscess through ophthalmologic referral and the use of diagnostic imaging. Both patients were successfully treated via incision and drainage.
KeywordsLacrimal gland abscess Bacterial Cellulitis CT
Lacrimal gland bacterial abscesses are uncommon and may arise in the setting of acute dacryoadenitis, which may in turn develop secondary to an adjacent infection, such as rhinosinusitis, from hematogenous spread of bacteremia or after trauma [1, 2]. We present two patients with lacrimal gland abscess presenting with preseptal cellulitis depicted on computed tomography (CT).
Although pyogenic lacrimal gland abscesses are rare, these lesions are of clinical significance since, as in this case, the abscess may not improve with medical therapy alone and may require surgical drainage. Furthermore, if inadequately treated, patients may progress to more widespread and sometimes life-threatening involvement including intracranial abscesses, meningitis, and cavernous sinus thrombosis .
Radiological imaging plays an important role in the evaluation of complicated orbital infections [3, 4]. Both CT and magnetic resonance imaging (MRI) of the orbits and brain with contrast are valid imaging modalities for the evaluation of intraorbital abscesses and associated intracranial abnormalities. Technique with low ionizing radiation dose can be implemented, particularly for pediatric patients, without significantly compromising diagnostic performance, as in case of patient 1. Imaging may also be useful for detecting potential predisposing factors, such as rhinosinusitis and lacrimal gland ductal cyst [1, 2].
Lacrimal gland abscesses appear as characteristic low-attenuation areas within an enlarged lacrimal gland on CT . There can also be diffuse enlargement and hyperenhancement of the affected lacrimal gland parenchyma surrounding the abscess. There is frequently associated orbital cellulitis. MRI with diffusion-weighted imaging can demonstrate restricted diffusion within the abscess. Nevertheless, the differential diagnosis for lacrimal abscess on imaging may include lacrimal gland tumors, lymphoproliferative disorders, foreign body granulomas, and sarcoidosis.
In conclusion, it is essential to recognize the presence of lacrimal gland abscesses, since these require incision and drainage. Therefore, diagnostic imaging of the orbits should be performed to evaluate for an underlying abscess in cases of medically refractory or atypical dacryoadenitis.
magnetic resonance imaging
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