IMAGES

Palpebral edema after facil trauma

NEREA YANGUAS BAREA¹, OLGA CONCEPCIÓN MARTORELL ALMAU², RAQUEL ARTAL SÁNCHEZ³
1
Sección de Radiodiagnóstico, 2Servicio de Urgencias, 3Servicio de Otorrinolaringología, Hospital Reina Sofía,
Tudela, Navarra, Spain.

A 64-year-old woman visited the emergency
department with self-limited epistaxis and abrupt
swelling of the eyelids after sneezing. She reported
having had an accidental fall with direct trauma to
the right malar area. On physical examination she
had emphysema of the right eyelids and ecchymo-
sis in the right malar region (Figure 1). Her pupils
were isochoric and normally reactive, vision was
unaffected with no oculomotor alterations. The
differential diagnosis was between orbital cellulitis,
sinusitis with extension to adjacent areas and
emphysema secondary to fracture. Computed to-
mography (CT) scan of the face (Figure 2), confir-
med fracture of the right lamina papyracea asso-
ciated with emphysema and hematoma.
Complications that might require surgery such as
muscle entrapment and retro-orbital hematoma
were ruled out. In the absence of other complica-
tions, symptomatic treatment was indicated, avoi-
ding Valsalva maneuvers and stress. The patient
showed favorable evolution and complete disappe-
arance of clinical symptoms two months later.

Figure 1. Emphysema of both eyelids and associated cutaneous ecchymosis.

Figure 2. Craniofacial CT without contrast in axial (left), coronal (middle) and sagittal (right) projections, showing
fractured right ethmoid lamina papyracea (arrows) with partial occupation of the ethmoid cells and abundant sub-
cutaneous and orbital emphysema (asterisks) and soft tissue edema.

CORRESPONDENCE: Nerea Yanguas Barea. Sección de Radiodiagnóstico. Hospital Reina Sofía. Ctra. de Tarazona, km. 3. 31500 Tudela,
Navarra, Spain. E-mail: nyambar@gmail.com
RECEIVED: 16-12-2011. ACCEPTED: 12-2-2012.
CONFLICT OF INTEREST: The authors declare no conflict of interest in relation with the present article.

Emergencias 2013; 25: 149 149