Subperiosteal Hemorrhage Research Articles

A case of irreducible shoulder dislocation as an initial manifestation of osteosarcoma of the proximal humerus

We experienced a case of osteosarcoma of proximal humerus with an initial clinical manifestation of irreducible shoulder dislocation. An eleven-year-old girl was transferred due to shoulder dislocation after minor collision, which could not be reduced even under anesthesia. After failed closed reduction under anesthesia, open reduction through deltopectoral exposure was performed evacuating the organized fibrous tissue, even without the suspicion of primary bone malignancy. Histopathologic report was osteosarcoma. Retrospective review of the imaging studies revealed subperiosteal hemorrhage, organized hematoma underneath the deltoid musculature, and osseous parenchymal changes, which suggested bone tumor. Subsequently, lung metastases were detected, and the chemotherapy was accompanied by neutropenic fever and Stevens Johnson syndrome. She expired 1 month thereafter. High index of suspicion would have led to more early diagnosis and established more appropriate management plan. Osteosarcoma of proximal humerus should be included in the differential diagnosis of a shoulder dislocation that could not be readily reduced.

Clinical and Radiologic Manifestations of Sickle Cell Disease in the Head and Neck

Sickle cell disease is a common inherited blood disorder that is characterized by the presence of sickle-shaped red blood cells. The clinical manifestations of sickle cell disease vary, but they may be attributed to three mechanisms: vaso-occlusion, chronic hemolytic anemia, and infection. The imaging appearances of central nervous system and musculoskeletal involvement by sickle cell disease have been well documented; however, involvement in the head and neck often is underappreciated, although it is not uncommon. In the head and neck, sickle cell disease can involve the inner ears, orbits, paranasal sinuses, bones, lymph nodes, and vessels. Manifestations of inner ear involvement include labyrinthine hemorrhage and labyrinthitis ossificans. In the orbits, they include lacrimal gland swelling, orbital wall infarction, and subperiosteal hemorrhage or fluid. In the paranasal sinuses, extramedullary hematopoiesis is seen. When bone is involved, infarction, osteomyelitis, bone marrow hyperplasia, and deposition of iron in bone marrow are seen in the maxillofacial bone and skull base. When lymph nodes are involved, lymphadenopathy is seen, and when blood vessels are involved, arterial stenosis and ectasia are seen. An understanding of the pathophysiology of sickle cell disease and knowledge of the various clinical and radiologic manifestations are crucial for prompt diagnosis and appropriate treatment.

Orbital Subperiosteal Hematoma From Scuba Diving

Only a few cases of nontraumatic orbital subperiosteal hematoma due to scuba diving have been reported, and this is the first of such cases that underwent surgical intervention. This injury results from negative pressure within the face mask, suctioning orbital tissues into the mask after incomplete equilibration of pressure on descent. Valsalva maneuver is a second mechanism implicated in the etiology of this injury. Recognition of this injury is of the utmost importance because vision loss is a possible complication if there is compression of the optic nerve or increased intraocular pressure. In many cases of nontraumatic orbital hematoma, conservative management is adequate; however, this case was an exception due to worsening exam findings. Divers may be able to prevent this injury by frequent and gentle equilibration of mask pressure on descent.

Spontaneous Subperiosteal Hematoma of the Orbit

Orbital subperiosteal hemorrhage is rare, with most cases occurring in young males as a result of direct facial or orbital trauma. The authors present a case of a spontaneous subperiosteal hematoma of the orbit in a 4-year-old girl.

Orbital Compression Syndrome in Sickle Cell Disease

To present 3 cases of orbital compression syndrome caused by infarction of the greater wing of the sphenoid in patients with sickle cell disease. Case report and review of the literature. Three patients with sickle cell disease (2 males aged 22 and 16 years, and a 10-year-old girl) who presented with proptosis, limited ocular motility, and chemosis were found to have an infarction of the marrow space of the greater wing of the sphenoid that produced an orbital subperiosteal hemorrhage and exudate demonstrated on MRI. Two patients suffered compressive optic neuropathy; both patients recovered normal optic nerve function. Orbital edema resolved within 48 hours of receiving 1 g methylprednosolone daily. The third patient had normal optic nerve function and his orbital edema improved with methylprednisolone 250 mg/day and intravenous Kefzol over 3 days. In the literature, there are 27 similar cases; 5 were treated surgically and the remainder were managed medically. Patients with sickle cell disease are at risk for orbital compression syndrome secondary to orbital bone infarction, in the setting of vaso-occlusive crises. This diagnosis should be considered when a patient with sickle cell disease presents with headache, proptosis, decreased motility, and/or optic nerve compromise.

Spontaneous Subperiosteal Orbital Hemorrhage Following Thrombolytic Therapy for Myocardial Infarction

A 60-year-old man experienced right orbital pain, periorbital swelling, and double vision 2 hours after treatment with streptokinase and heparin for myocardial infarction. Orbital CT revealed a right superior subperiosteal orbital hemorrhage. Conservative management in the absence of visual compromise was sufficient, as his symptoms and signs resolved completely in approximately 6 weeks with no recurrence during 6 months of follow-up. This case demonstrates that nontraumatic subperiosteal orbital hemorrhage may occur after thrombolytic therapy for myocardial infarction. Conservative treatment with cold compresses in the absence of visual impairment may be sufficient, as was in our patient and others.

Subperiosteal Orbital Hemorrhage Following Self-strangulation

Subperiosteal orbital hematomas are uncommon. The delayed presentation of such an event is described in an anticoagulated patient who attempted self-strangulation. Despite the initial presence of a relative afferent pupillary defect, excellent visual recovery occurred, demonstrating the importance of prompt recognition and treatment. The causes, mechanism of visual loss, radiographic diagnosis, and treatment of subperiosteal hemorrhages are discussed.

Spontaneous hemorrhage simulating rapid growth of a benign subperiosteal plexiform neurofibroma

Spontaneous subperiosteal hemorrhage is a rare complication of von Recklinghausen's disease. There are few reports describing the MR imaging characteristics of this entity. Our case is unique among these as an underlying plexiform neurofibroma was visualized by MR imaging. We present a 12-year-old child with neurofibromatosis 1 who presented with a rapidly enlarging mass of the fibula. Surgery and pathology revealed subperiosteal hemorrhage into a benign, plexiform neurofibroma. The MR imaging features, pathogenesis and clinical implications of this entity are discussed. Recognition of this disease process and differentiating it from malignant transformation can prevent unnecessary surgery.

Delayed Orbital Subperiosteal Hemorrhage After Blunt Trauma

A 21-year-old man presented with sudden-onset orbital hemorrhage, vision loss, and epistaxis 4 days after experiencing blunt trauma. Computed tomography revealed a subperiosteal hematoma in the medial orbit, extending to the orbital apex, and fractures of the medial and inferior orbital walls. After the hematoma was evacuated through a medial orbitotomy, orbital and visual symptoms improved. Although rare, vision-threatening subperiosteal hemorrhages may develop days after blunt orbital trauma and may require surgical evacuation.

Orbital Subperiosteal Hemorrhage while Scuba Diving

Purpose: To report an uncommon case of unilateral subperiosteal hemorrhage while scuba diving involving the orbit, a condition characterized by proptosis and associated severe ocular motility disturbances with displacement of the eyeball. Material and Methods: Observational case report. Results: Unilateral subperiosteal hemorrhage in a 31-year-old woman while scuba diving at a depth of 20 meters. This was documented by clinical and radiographic examination. Computed tomography (CT) scan demonstrated a subperiosteal hemorrhage as a self-limited mass protruding into the left orbit. The process resolved without treatment and without visual or motility sequelae. A CT-scan, nuclear magnetic resonance, and conventional angiography did not show any venous abnormalities in the brain. Conclusion: During scuba diving at a depth of 20 meters, the pressure is three atmospheres, whereas within the diving mask the pressure is one atmosphere if it is not equilibrated; thus, a negative pressure is created within the mask. Small vessels can be broken in the conjunctiva or subperiosteal space by this force. It is important to exclude vascular abnormalities, especially if there is a positive family history.

Diagnosis and Treatment of Orbit Posttraumatic Subperiosteal Hemorrhage in a Child, Associated with a Subdural Intracranial Hemorrhage

We describe a rare case of traumatic subperiosteal orbital hematoma in a child, with intracranial hemorrhagic complication. Subperiosteal hematoma are the more infrequent occurrences among intraorbital hemorrhagic lesions and can be also associated with intracranial extradural hematoma in patients with orbital roof fracture. Here, we describe a case without roof fracture but with a never-before described intracranial subdural hematoma. The patient underwent computed tomography and magnetic resonance imaging, in an acute state, and later, a radiologic diagnosis of percutaneous drainage of the hematoma was mad. MRI was more sensitive and specific in the evaluation of the intracranial and intraorbital complication.

Nontraumatic Subperiosteal Orbital Hemorrhage in an Elderly Man

We report a 70-year-old man who presented with sudden onset of left eye proptosis, ptosis and diplopia after severe vomiting. Radiological studies showed a subperiosteal hematoma. Conservative treatment was given and no vision-threatening problem in the patient was noted during follow-up. The left eye proptosis and ptosis completely resolved three months later. Extraocular movement also returned to normal and no dipolpia was noted. Nontraumatic subperiosteal orbital hemorrhage may occur at any age, but the incidence decreases with age. The most common site of subperiosteal hemorrhage is the orbital roof. The clinical and radiological features are sufficiently characteristic to allow for conservative treatment in the absence of visual compromise.

Orbital Subperiosteal Hemorrhage in a Patient With Factor VIII and Factor XII Deficiency

Orbital subperiosteal hemorrhage may develop from the orbital extension of a subgaleal hemorrhage and threaten vision. This article describes the case of a patient with factor VIII and factor XII deficiency who had a subgaleal hemorrhage with orbital extension and optic nerve compression following head trauma.

Orbital haemorrhage with loss of vision in a patient with disseminated intravascular coagulation and prostatic carcinoma

A 65-year-old man with sudden profound loss of vision in his right eye due to sub-periosteal orbital haemorrhage was found to have disseminated intravascular coagulation (DIC) secondary to metastatic prostatic carcinoma. CT-scan did not reveal any orbital metastases. A lateral canthotomy did not help to restore the vision. Orbital haemorrhage is known to occur with DIC due to different causes. To the best of our knowledge this is the first report of orbital haemorrhage with DIC related to prostatic carcinoma. This case emphasises the importance of considering systemic factors in cases of non-traumatic haemorrhage, along with imaging studies to rule out any co-existing vascular anomaly.

Subperiosteal orbital hemorrhage as initial manifestation of Christmas disease (factor IX deficiency)

PURPOSE: To report a case of subperiosteal orbital and subgaleal hemorrhage with optic nerve compromise in a patient with a factor IX deficiency. DESIGN: Interventional case report. METHODS: A 5-year-old male presented 10 days after mild trauma with progressive left-sided scalp swelling, proptosis, and visual loss. RESULTS: The patient had marked proptosis of the left eye, 20/200 visual acuity, and an afferent pupillary defect. Magnetic resonance imaging demonstrated a large subgaleal and left subperiosteal orbital hematoma. Quantitative assays of coagulation proteins identified a factor IX deficiency (Christmas disease). CONCLUSION: Delayed-onset subgaleal and subperiosteal orbital hematoma can rarely be an initial manifestation of Christmas disease.

Nontraumatic subperiosteal orbital hemorrhage

Purpose Nontraumatic subperiosteal orbital hemorrhage (NTSOH) has been reported rarely in association with sudden elevation of cranial venous pressure, generalized diseases with bleeding diatheses, and paranasal sinusitis. To define more clearly the clinical and imaging characteristics of NTSOH, we evaluated nine cases seen by the authors and reviewed previous case reports. Design Retrospective, noncomparative case series. Participants Nine patients (10 eyes) with NTSOH. Intervention All patients underwent computed tomography scans of the orbits. Patients with typical clinical and imaging features and normal visual function were observed. Those with an uncertain diagnosis or visual compromise underwent surgical drainage of the hematoma. Main outcome measures Resolution of proptosis, diplopia, lid swelling, and ptosis. Results Nine patients ranging from birth to 73 years of age were identified. All were females. The lesions were located superiorly in eight patients (one patient had bilateral lesions) and medially in one patient. Most were associated with sudden elevation in venous pressure (vomiting, strangulation, straining), and most required no surgical intervention. The bilateral case occurred in the setting of disseminated intravascular coagulation and was the only case associated with visual loss possibly resulting from ischemic optic neuropathy. Conclusions Nontraumatic subperiosteal orbital hemorrhage may occur at any age, usually secondary to sudden elevation in venous pressure. It is nearly always superior. The clinical and radiologic features are sufficiently characteristic to allow conservative treatment in the absence of visual compromise.

Bilateral orbital hemorrhage in a newborn

PURPOSE: To report a case of severe bilateral proptosis resulting from orbital hemorrhage in a newborn and to discuss the differential diagnoses and management. METHOD: Case report of a 13-day-old male infant with bilateral proptosis since birth. The proptosis was monitored with clinical examinations and computed tomography as well as magnetic resonance imaging (MRI) scans, and it was managed with antibiotic ointment and patching. The MRI scans demonstrated bilateral subperiosteal orbital hemorrhage. RESULTS: Proptosis decreased, and there was successful, complete recovery without untoward sequelae in 14 days; follow-up indicated no late complications at age 1 year. CONCLUSION: Spontaneous orbital hemorrhage, unilateral or bilateral, is uncommon in an otherwise healthy newborn without apparent history of birth trauma. Magnetic resonance imaging scans are helpful in making the diagnosis of subperiosteal hemorrhage, and conservative management is advised.

Subperiosteal orbital hemorrhage from retrobulbar injection resulting in blindness: Dortzbach K. Arch Ophthalmol 115:123, 1997

Subperiosteal orbital hemorrhage from retrobulbar injection resulting in blindness: Dortzbach K. Arch Ophthalmol 115:123, 1997

Subperiosteal bone proliferation at the tibia in neurofibromatosis — a case report

A very rare case of subperiosteal bone proliferation described as ‘a bone cyst’ on the distal end of the tibia in association with neurofibromatosis is reported in a 9-year-old girl. The pathological finding progressed within 6 months from ‘a cyst-like bone lesion’ filled with haematoma to ‘a bony protuberance’ and is documented with plain X-rays, CT and MRI, and subperiosteal haemorrhage on the tibia was strongly suspected. Clinical findings met the NIH criteria for neurofibromatosis, and the histopathological features were consistent with neurofibromatosis. To our knowledge, only 21 cases of this lesion have been reported in the literature. The cause of this lesion is the subperiosteal haemorrhage caused by periosteal abnormalities due to inversion by neurofibromatosis or mesodermal dysplasia. In spite of their frequent recurrences these lesions become huge and cause deformity and they should be resected before functional and cosmetic problems occur.

Trephination as a possible treatment for scurvy in a middle bronze age (ca. 2200 BC) skeleton

AbstractAlthough trephination of sub‐adults in antiquity is rare, scurvy both infantile and adult, is even more rare in the archaeological record. Pathological changes appearing in the maxilla, mandible and orbits of a child of 8–9 years of age are highly suggestive of infantile scurvy. Advanced forms of this metabolic disturbance lead to severe subperiosteal haemorrhaging, at times turning the skin of the face and skull black. This condition may have led to the trephination along the sagittal suture as a form of blood letting in hopes of draining the subperiosteal haemorrhage in the cranium. Although cause and effect are often confusing in antiquity, the surgical intervention presented here led to the ultimate death of the child.