IMAGES IN EMERGENCY MEDICINE Sudden onset proptosis: a rare

presentation of sinusitis CASE REPORT A 45-year-old male presented to the emergency department with sudden onset left-sided orbital swelling, ecchymosis and decrease in vision. Examination revealed left-sided proptosis, a well demarcated blue swelling of his left eye, visual acuity of 6/6 (R) and 6/24 (L), limited eye movements in all directions, with absent downward gaze. MRI reported an extensive inflammatory phlegmon involving the medial and superior aspect of the left orbit with a peripher-ally enhancing phlegmon tissue causing the patient’s proptosis (see figure 1). Flexible endoscopy found bilateral pus in the middle meatus with adhesions between the left lateral wall and the septum, and a small ethmoidal polyp on the left side. A diagnosis of acute inflammatory sinusitis with associated intraorbital extension and associated phlegma of inflammatory change without evidence of intracranial complications was made. This presentation of sinusitis is more common in the paediat-ric population, and is associated with the rare complication of Pott’s Puffy tumour.1 It is important to consider sinusitis in the differential for periorbital swelling in the general population to prevent sinister complications