Subperiosteal hematoma in multiple settings

Subperiosteal Orbital Hematoma: An Uncommon Complication of Acute Sinusitis

Non-traumatic subperiosteal orbital hematoma is a rare finding and uncommon cause of proptosis. Reported cases describe an association with increased venous pressure. However, it is important to note that there is also an association with sinusitis, which must be differentiated from subperiosteal abscess. This article describes the unique imaging features of subperiosteal hematoma in the setting of sinusitis, as well as the suspected pathophysiology.

Nontraumatic subperiosteal orbital hemorrhage in a laboring patient with gestational immune thrombocytopenic purpura

Purpose

To describe a case of nontraumatic subperiosteal orbital hemorrhage (NTSOH) in a laboring patient with gestational immune thrombocytopenic purpura.

Observations

A 28-year-old G3P2 laboring patient was urgently evaluated by our ophthalmology unit after she developed sudden onset left eye proptosis, headache, and diplopia in the final hour of pushing. The patient's platelet count was markedly decreased at 45,000 and subsequent work-up established a diagnosis of gestational immune thrombocytopenic purpura. On examination, visual acuity was 20/25 bilaterally and there was a minus two restriction in upgaze in the left eye and a left hypotropia in primary position. Computed tomography demonstrated an elliptical, hyperdense collection at the left orbital roof consistent with NTSOH. The patient was deemed clinically stable through serial examinations and symptoms resolved with conservative management.

Conclusions and Importance

NTSOH is a rare, potentially sight-threatening condition that requires timely ophthalmological evaluation. To our knowledge, this is the first report in the literature of NTSOH in a laboring patient with gestational immune thrombocytopenic purpura. Consideration of the possibility of NTSOH as a complication in this population may allow for appropriate diagnosis, monitoring, and treatment when indicated.

Subperiosteal haematoma of the orbit secondary to frontal sinusitis

Reported is the case of a 79-year-old woman initially diagnosed with periorbital abscess on the background of a recent upper respiratory tract infection. Unexpectedly, intraoperative findings were that of a haematoma rather than an abscess. Subperiosteal orbital haematoma (SOH) is an extremely rare complication of rhinosinusitis. In contrast to the more common periorbital abscess, it is seldom listed as a complication of sinusitis. A review of reported cases suggests an older patient demographic are affected by SOH in contrast to periorbital abscess which typically affects paediatric patients. Given current demographic trends toward an older patient population with multiple comorbidities, failure to consider SOH as a differential will have important implications on preoperative workup, perioperative care and final outcome for patients. We present this case as a reminder of a rare but important complication of a common disease.

Subperiosteal Hematoma of the Iliac Bone: An Unusual Cause of Acute Hip Pain after a Fall

BACKGROUND Subperiosteal hematoma (SPH) of the iliac bone is an extremely uncommon clinical entity that occurs mostly in young patients with a history of a recent fall or sports-related injury. Patients usually complain of severe hip pain after a fall, mimicking femoral neck fracture. CASE REPORT An 18-year-old female was transported to our hospital complaining of pain in her left hip after falling on her buttocks while engaging in martial arts. Ultrasound of her left iliac region revealed a subperiosteal mass on the internal aspect of the iliac bone lifting the iliac muscle. SPH of the iliac bone was suspected, which was also evident on pelvis and hip magnetic resonance imaging. Repetitive ultrasound did not reveal hematoma expansion. She was discharged from the hospital the next day without femoral neuropathy. CONCLUSIONS Physicians should be aware of our report, which highlights a patient with the rare clinical condition of SPH of the iliac bone occurring immediately after a fall. The differential diagnosis of acute hip pain, which mimics femoral neck fracture, should be considered in young patients. Ultrasound of the iliac region may be useful in detection and further management of SPH of the iliac bone.

Emesis-induced sub-periosteal haematoma: a case report

BACKGROUND

Orbital sub-periosteal haematoma (OSH) is usually caused by orbital trauma. We present a case of spontaneous OSH and review the literature on this condition.

METHODS

We present a case of sub-periosteal haematoma secondary to migraine and vigorous emesis.

DISCUSSION

OSH is very rare; this case highlights the clinical features of the condition and that rapid spontaneous resolution can occur. We review the literature on emesis- or valsava-induced OSH and discuss possible mechanisms for its formation in conjunction with migraine.