Orbital emphysema as a rare complication of asthma exacerbation in a pediatric patient; A case report

Abstract

Introduction: Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SCE) are well-known complications of asthma. Orbital emphysema (OE) is a rare complication, with little known of its pathogenesis and clinical significance. This report presents a case of OE associated with asthma exacerbation in a pediatric patient.

Presentation of case: An 8-year-old girl with a history of asthma treatment developed wheezing and periorbital swelling around her right eye following influenza A infection. She had no history of trauma, nose blowing, or recent surgery. Head and chest computed tomography revealed SPM, massive SCE, and right OE. Intraocular pressure and visual acuity were normal. OE, SCE, and SPM were completely resolved through conservative management, without any sequelae.

Discussion: OE may be associated with asthma exacerbation in pediatric patients. We hypothesized that the massive SCE and SPM, which developed as a result of asthma exacerbation, spread through the fascial planes, leading to the development of OE.

Conclusion: OE is typically a benign self-limiting condition; however, it may lead to serious complications such as orbital compartment syndrome. Clinicians should consider OE in patients with asthma who present with sudden orbital symptoms, even in the absence of a history of trauma.

Keywords: Asthma; Case report; Orbital emphysema; Spontaneous pneumomediastinum; Subcutaneous emphysema.

Fig. 1

Periorbital swelling of the right eye in a female patient.

Fig. 2

A frontal chest radiograph showing pneumomediastinum (red arrows in the middle) and subcutaneous emphysemas (red arrows in the upper and lower chest).

Fig. 3

A. Axial chest computed tomography showing subcutaneous emphysema (red arrow) and pneumomediastinum (black arrow). B. Computed tomography (CT) showing a continuous distribution of air from the mediastinum to the cervical soft tissue.

Fig. 4

A. Axial computed tomography of facial bones showing orbital emphysema (red arrow). B. Axial computed tomography of facial bones showing subcutaneous periorbital emphysema (red arrow).