title: Paediatric post-septal and pre-septal cellulitis: 10 years' experience at a tertiary-level children's hospital.
abstract: OBJECTIVE
  To assess the incidence and complications of pre-septal (pre-SC) and post-septal (post-SC) cellulitis over 10 years. Pre-SC and post-SC are also known as periorbital and orbital cellulitis, respectively.
  
  
  METHODS
  Retrospective analysis of CT scans. Data included the presence of pre-SC and post-SC, paranasal sinus disease (PNS) and complications.
  
  
  RESULTS
  Among 125 patients scanned for these suspected diagnoses, 67 had both pre-SC and post-SC, 37 had pre-SC and 4 had post-SC; there were 17 normal scans. 110 patients had PNS. 68/71 (96%) patients with post-SC had PNS. Post-SC complications included orbital and/or subperiosteal abscess (50/71: 30 medial orbital, 10 superomedial, 3 lateral, 2 anteromedial, 2 inferomedial, 1 superior, 1 anterosuperior and 1 not specified), cavernous sinus thrombosis (CST) (1), superior ophthalmic vein (SOV) thrombosis (4) and subdural frontal empyema (2); 1 patient had SOV and CST and subdural empyema.
  
  
  CONCLUSIONS
  71/125 (57%) patients had post-SC. 50/125 (40%) patients imaged for pre-SC/post-SC had orbital abscess; 44/50 (88%) of these involved the medial orbit. Patients can develop solely superior or inferior abscesses that are difficult to identify by axial imaging alone, hence coronal reformatted imaging is essential. 5/125 (4%) patients developed major complications (SOV/CST/empyema), hence imaging review of the head and cavernous sinus region is essential. A diagnosis of post-SC on CT should alert the radiologist because this diagnosis can be associated with an increased incidence (5/71, 7%) of complications.
  
  
  CONCLUSIONS
  We recommend that all patients with a suspected diagnosis of post-SC should undergo CT scan (post-contrast orbits and post-contrast head, with multiplanar reformats and a careful review of the SOV and the cavernous sinus). Particular attention should be paid to exclude intracranial complications including subdural empyema and cerebral abscess. As soon as a diagnosis of post-SC is made, in addition to informing the referring clinical team, urgent opinion should be sought from ear, nose and throat (ENT), neurology and ophthalmology with a view to urgently drain of the paranasal sinuses`.
authors.affiliation: Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: A V
authors.initials: AV
authors.lastname: Mathew
authors.forename: E
authors.initials: E
authors.lastname: Craig
authors.forename: R
authors.initials: R
authors.lastname: Al-Mahmoud
authors.forename: R
authors.initials: R
authors.lastname: Batty
authors.forename: A
authors.initials: A
authors.lastname: Raghavan
authors.forename: S R
authors.initials: SR
authors.lastname: Mordekar
authors.forename: J
authors.initials: J
authors.lastname: Chan
authors.forename: D J A
authors.initials: DJ
authors.lastname: Connolly
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000293:Adolescent; D002481:Cellulitis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D013354:Empyema, Subdural / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed