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Resolution
The x-ray shows air in the orbit, which may indicate a fracture of the orbit and communication with an airspace in the skull.
The swelling stemmed from subcutaneous emphysema – itself a sign of orbital fracture.
This patient was referred for CT evaluation.
It should be noted that the false negative rate with plain films for facial trauma is high. CT is the study of choice. If CT is not available, referral should be based on clinical suspicion in light of the history and physical findings. High-energy trauma deserves a high index of suspicion.
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel.
Clinical Challenge: December, 2010
Nahum Kovalski, BSc, MDCM
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