Question
A 13-year-old boy is brought to the emergency room 30 minutes after being hit in the face with a baseball at high velocity. Examination shows left periorbital swelling, posterior displacement of the left globe, and tenderness to palpation over the left infraorbital rim. There is limited left upward gaze and normal horizontal eye movement. Further evaluation is most likely to show which of the following as a result of this patient’s trauma?
| A. |
Injury to lacrimal duct system
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| B. |
Clouding of maxillary sinus
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| C. |
Pneumatization of frontal sinus
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| D. |
Cerebrospinal fluid leak
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Show Answer
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Correct Answer � B
Explanation
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Answer B) Clouding of maxillary sinus
The patient’s findings of enophthalmos (posteriorly displaced eye) and infraorbital rim tenderness are suggestive of an orbital floor fracture (orbital blowout fracture). The mechanism of this injury can lead to downward displacement of orbital fat and inferior rectus muscle entrapment, which in turn can cause impaired upward gaze.
Clouding of maxillary sinus
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Clouding of the maxillary sinus is a radiological sign that is also known as the ‘tear drop sign’.
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It will most likely be seen on further evaluation due to the inferior rectus muscle and orbital fat herniation through the fractured orbital floor.
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Other symptoms may include diplopia, crepitus, and ecchymosis.
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