Imaging Case of the Week 47

This is the facial x-ray of a 25 year old man who has been punched in the face. What interesting radiological sign can you see?

facial x-ray

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The facial x-ray shows ‘black eyebrow sign’ in the left orbit. There is a lucent area at the superior aspect of the orbit simulating black eyebrow. It suggests the presence of an orbital blowout fracture.

Air enters the orbit secondary to breach in the wall of maxillary sinus (as in this case) but it could also be due to involvement of the ethmoid sinus.

In the above x-ray, there is also fluid in the left maxillary sinus which, in the context of the trauma, indicates blood.

Black eyebrow sign may be the only plain x-ray finding in patients with orbital blowout fracture.

Left orbital emphysema

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3 thoughts on “Imaging Case of the Week 47

  1. Great sign, thank you! I initially thought there is also a irregularity over the orbital margin of the frontal process of right zygomatic bone. obviously clinical correlation would be necessary.

    I recommend this site for all my colleagues who also struggle with all overlapping bones and shadows on facial xrays.: :))

    • Thanks Raf. Facial x-rays can be tricky to interpret. It is important to compare the injured with the normal side. Following the 3 Mcgrigor’s lines diligently is a great way to spot abnormality. The website that you have mentioned has further details on the Mcgrigor’s lines.

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