The American journal of emergency medicine
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Case Reports
Spontaneous subperiosteal orbital hematoma in a patient with chronic sinusitis: A case report.
Periorbital swelling is a common presentation to the emergency department (ED), and its etiology can range from benign to acutely vision-threatening. Orbital subperiosteal hematoma is a rare ED diagnosis that is typically associated with trauma, though can infrequently occur spontaneously in the setting of sudden elevations in cranial venous pressure, bleeding diathesis, and sinusitis. We present a case of a 55-year-old female with a history of chronic sinusitis who presented to the ED with a three-day history of left-sided periorbital swelling along with painful extraocular movements and markedly decreased visual acuity following a cross-country road trip through elevation. ⋯ Intravenous antibiotics were started immediately and the patient underwent surgical incision and drainage of the subperiosteal space, where she was diagnosed with a spontaneous subperiosteal orbital hematoma secondary to chronic sinusitis. Within the literature, there are fewer than 20 case reports of orbital subperiosteal hematoma secondary to sinusitis. The purpose of this case report is to assist emergency physicians in considering the rare but potentially vision-threatening condition of spontaneous subperiosteal orbital hematoma within their differential diagnosis of patients with periorbital swelling and proptosis, as well as to provide an approach to management within the ED.
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We present the case of a 2-month-old adopted female seeking evaluation in the pediatric emergency department due to a one-day history of decreased right arm movement and fussiness. The physical exam was largely unremarkable with the exception of decreased spontaneous movement of the right upper extremity, obvious discomfort with passive movement and subtle edema of the forearm. Because of concern for non-accidental trauma, plain films were obtained which revealed no signs of traumatic injury. ⋯ These abnormalities led to the consideration of congenitally acquired infections, specifically syphilis, and serologies were confirmatory. Ultimately, the infant was diagnosed with Pseudoparalysis of Parrot - a rare musculoskeletal manifestation secondary to painful syphilitic periostitis. As Emergency Medicine physicians, it is important to be aware of the growing burden of syphilis infection and reacquaint ourselves with its numerous presentations in the young infant.