Resolution
The circled portion of the x-ray shows an air-fluid level in the right maxillary sinus. This raises the possibility of an orbital fracture with bleeding into the sinus.
It is very important to verify that there is no limitation in range of motion (ROM) of the eye (i.e., entrapment).
CT of the facial bones, whenever available, is becoming the standard for imaging facial trauma. CT is extremely useful for identifying soft tissue complications of facial bone fractures and assists with disposition management.
Consultation with a facial surgeon (usually plastic surgery or otolaryngology) is necessary for all suspected facial bone fractures.
Acknowledgement: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
These cases are among hundreds that can be found in Terem’s online x-ray Teaching File, with more being added daily. Free access to the file is available at https://www2.teremi.com/xrayteach/. A no-cost, brief registration is required.
