The role of ultrasonography in differential diagnosis of orbital lesions

Lanni, Vittoria; Iuliano, Adriana; Fossataro, Federica; Russo, Camilla; Uccello, Giovanni; Tranfa, Fausto; Strianese, Diego; Vallone, Gianfranco

doi:10.1007/s40477-020-00443-0

Cited by 7 publications

(15 citation statements)

References 22 publications

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“…Overall sensitivity of ultrasound for detecting orbital lesions has been reported to be as high as 94%. 15 In paediatric patients with orbital pathologies, ultrasound is an excellent modality owing to its inherent benefits of lack of radiation and no need for sedation. Use of ultrasound can thus be streamlined into the workup of orbital and ocular pathologies as an initial step to decide further best investigation, as a problem-solving tool in cases with a diagnostic dilemma on other modalities and for follow-up of cancer patients on a case-to-case basis.…”

Section: Discussionmentioning

confidence: 99%

Paediatric orbital ultrasound: Tips and tricks

Gupta

Arora

Seth

et al. 2022

Australas J Ultrason Med

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Background The orbital structures are ideally suited for ultrasound examination due to their superficial location and cystic composition of the eye. However, orbital ultrasound remains an underutilised modality due to preference for other cross‐sectional modalities in general practice. Aim In this article, we review the basic principles, clinical uses and technique of orbital ultrasound in peadiatric patients. Materials and methods The clinical utility of orbital ultrasound in peadiatric patients is demonstrated using selected cases. Results Ultrasound is useful in the diagnosis of various posterior segment pathologies, especially in conditions causing opacification of light‐conducting media of the eye. It is also beneficial in diagnosing various orbital pathologies, particularly in differentiating solid from cystic lesions. Discussion The added advantages of its use in children include lack of ionising radiation and reduced requirement of sedation or general anesthesia. Ultrasound is the most practical initial investigation in cases where ophthalmoscopy is limited by opacification of ocular media. The addition of color Doppler on ultrasound can give additional information about the vascularity of the lesion. Conclusion Use of ultrasound can be streamlined into the workup of various orbital and ocular pathologies either as an initial investigation or as a problem‐solving tool in cases with a diagnostic dilemma on other modalities.

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Section: Discussionmentioning

confidence: 99%

Paediatric orbital ultrasound: Tips and tricks

Gupta

Arora

Seth

et al. 2022

Australas J Ultrason Med

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“…As recurrence and revascularization of residual lesions are common, OVM surgical management is controversial. Furthermore, surgery carries a risk of damaging normal structures depending on location and extent of the lesion (10)(11)(12). Taking into account the relationships between orbital structures and vascular dynamics, the surgical approach should be tailored for each lesion (13).…”

Section: Discussionmentioning

confidence: 99%

“…Taking into account the relationships between orbital structures and vascular dynamics, the surgical approach should be tailored for each lesion (13). In severe cases, when extensive deep orbital lymphatic-venous malformation cause blindness and eye pain together with severe cosmetic disfigurement, orbital exenteration can be considered (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Reconstruction of the enucleate pediatric orbit poses a different set of challenges both for the psychological effects on child and parents and for the long-term orbital growth.…”

Section: Discussionmentioning

confidence: 99%

“…Medical management is recommended and useful in different cases; nevertheless, in the presence of optic neuropathy, owing to optic nerve compression or stretching, anisometropy or significant cosmetic deformity surgery is indicated. In severe cases, when an orbital lymphatic-venous malformation is localized in the posterior orbit presenting with a blind and painful eye, orbital exenteration can be considered even in the pediatric population ( 11 ). Surgical management of enucleated orbital region in children, differently from the adults, represents a demanding procedure because of the intrinsic relation between volume replacement and normal orbital growth.…”

Section: Introductionmentioning

confidence: 99%

“…Accurate diagnosis and localization of these lesions are essential for proper management to avoid serious complications. There is no current consensus on the first-line treatment for OVM and both surgical and non-surgical approaches have been proposed (10)(11)(12)(13)(14). Roughly, 50% can be managed conservatively once the diagnosis has been made (7).…”

Section: Introductionmentioning

confidence: 99%

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The Versatility of the Free Vastus Lateralis Muscle Flap: Orbital Reconstruction After Removal of Complex Vascular Malformation in a Pediatric Patient

et al. 2021

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Introduction: Vascular orbital lesions in pediatric population represent a demanding therapeutic challenge which requires a multidisciplinary team. In severe cases, orbital enucleation can be considered. Surgical management of enucleated orbital region in children, differently from the adults, represents a challenging procedure owing to the intrinsic relation between volume replacement and normal orbital growth. Many reconstructive options have been proposed, and many donor sites have been utilized for this purpose but each one have demonstrated potential disadvantages. Despite its well-known versatility, no report of the vastus lateralis free flap in children requiring orbital reconstruction exists in literature. Herein, we propose this surgical strategy as a valid option for the reconstruction of an extended orbital defect in a pediatric patient suffering from a mixed type of vascular malformation.Material and Methods: A patient was referred from a foreign country with an unclear medical history, presenting exorbitism and exophthalmos, proptosis of the eyeball, visus 4/10, and limited ocular motility. We made clinical-instrumental investigations with a diagnosis of complex vascular malformation. It expanded in intraorbital and retrorbital space with bulb anterior dislocation and optic nerve involvement. We performed an emptying of the orbital content via transconjunctival and via coronal incision with eyelid preservation. A free vastus lateralis muscle flap was used for reconstruction, filling the orbital cavity. We anastomosed the flap on the superficial temporal artery. An ocular conformator was then positioned.Results: We report the result at 12 months, showing a good orbital rehabilitation with an adequate prosthetic cavity, a good recovery of volume and facial symmetry, guaranteeing balanced orbital and periorbital growth. There were no major or minor complications associated with the procedure.Discussion: The reconstruction of the orbit remains a “surgical challenge” both in adults, whose goal is the restoration of volume, adequate symmetry and facial esthetics, and children, in which correcting the asymmetry has the additional objective to balance orbital growth. Many reconstructive techniques have been proposed, including the use of free flaps. The versatility of the free vastus lateralis muscle flap is well-known. It offers adequate amount of tissue with minimal morbidity to the donor site, provides a long pedicle, gives the possibility of simultaneous work in a double team, and has a constant anatomy and a safe and rapid dissection. There are no descriptions of its use for pediatric orbital reconstructions.Conclusions: In our opinion, the free vastus lateralis flap should be included as one of the best option for orbital pediatric reconstruction after enucleation.

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Assessing the Usefulness of Ultrasonography for the Diagnosis and Evaluation of Intra‐Orbital Lesions in Pediatric Patients

Hosokawa,

Kuntaro,

Takei

et al. 2023

J of Ultrasound Medicine

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ObjectivesTo assess the usefulness of ultrasonography in the diagnosis and evaluation of extraocular intra‐orbital lesions in pediatric patients.MethodsTwenty‐three pediatric patients with intra‐orbital lesions who underwent both ultrasound and computed tomography/magnetic resonance imaging (CT/MRI) were included. The following parameters were evaluated using ultrasound: 1) lesion detection rate (presence or absence of lesions), 2) lesion characteristics, 3) lesion location (extraconal or intraconal), and 4) the lesion longest linear dimensions, and these were compared using Fisher's exact test and Mann–Whitney U test.ResultsTwo lesions could not be detected using ultrasound; in the other 21 cases, the lesion characteristics diagnosed by ultrasound were correct. Diagnostic accuracy of detection and characteristics assessment using ultrasound were 91.3% and 91.3%, respectively. The lesion location was not significantly different between the two groups (intraconal/extraconal in those detected using ultrasound versus those in the absence on ultrasound = 7/14 versus 0/2, P > .999); however, in two cases that were not detected on ultrasound, the lesions were located at extraconal. Lesions that were small in longest linear dimensions on CT/MRI were not detected using ultrasound (the longest linear dimensions in lesions detected using ultrasound versus that in the absence of ultrasound: 29.5 ± 8.2 [range, 13–46] versus 10 and 11 mm, P = .043).ConclusionsUltrasonography proved to be useful for visualizing and evaluating intra‐orbital lesions except for lesions that were relatively small in size. Therefore, although ultrasound could not detect lesions located behind bone and bone invasion, it could be used for diagnosing and selecting treatment strategies for intra‐orbital lesions.

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The role of ultrasonography in differential diagnosis of orbital lesions

Cited by 7 publications

References 22 publications

Paediatric orbital ultrasound: Tips and tricks

Paediatric orbital ultrasound: Tips and tricks

The Versatility of the Free Vastus Lateralis Muscle Flap: Orbital Reconstruction After Removal of Complex Vascular Malformation in a Pediatric Patient

Assessing the Usefulness of Ultrasonography for the Diagnosis and Evaluation of Intra‐Orbital Lesions in Pediatric Patients

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