Imaging Case of the Week 550 Answer

The facial x-ray (OM view) shows

  1. Irregularity of the left infra-orbital wall.
  2. Left orbital emphysema (black eyebrow sign)
  3. Fluid in the left maxillary antrum likely blood in the context of trauma.

Pay attention to soft tissue signs which in the above image is represented by gas in the left orbit and fluid in the maxillary antrum. The infra-orbital wall almost appears normal.

Orbital emphysema can lead to orbital compartment syndrome. Full eye assessment and early specialist referral is a must.