Orbital Subperiosteal Hematoma in the Newborn Causing Unilateral Proptosis: Ultrasound as First-Line Imaging Modality (original) (raw)

2017, American Journal of Perinatology Reports

A male infant was born at term to a 31-year-old, gravid 3 para 2 mother by precipitous spontaneous vaginal birth. Pregnancy and third trimester fetal ultrasound scan were unremarkable. Apgar scores were 7 (1 minute) and 9 (5 minutes). Birth weight was 3,815 g (75th percentile). Facial suffusion was noted immediately after birth and intramuscular vitamin K was administered shortly after birth. At 16 hours of age, proptosis of the right eye was noted with associated subconjunctival hemorrhage, right-sided hypotropia, and impaired right lateral gaze (►Fig. 1a). The cornea appeared clear bilaterally, pupils responded to light symmetrically, both fundi and the baby's physical examination were unremarkable. A full blood count and coagulation profile were unremarkable (results not shown). Imaging and Clinical Course Orbital ultrasound demonstrated a well-defined hypoechoic, nonvascular 13 Â 9 mm mass in the superior aspect of right orbit, exerting mass effect and scalloping the retroorbital fat and superior rectus muscle (►Fig. 1b, calipers, contralateral eye not shown). A cranial magnetic resonance imaging (MRI) study on day 12 of life demonstrated an ellipsoid lesion measuring 19.8 Â 22.8 Â 11 mm with elevation of the roof of the right orbit. The lesion was hyperintense on T1 and showed mixed intensity on T2 sequences (►Fig. 1c). There Keywords ► newborn ► orbital ► subperiosteal ► hematoma ► proptosis ► ultrasound