ArticleBMC pediatrics2025
Pediatric orbital emphysema and pneumocephalus following a compressed air gun injury: a case report.
Article in BMC pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOrbital emphysema and pneumocephalus rarely occur without associated skull fractures. Over the past decades, a few case reports have documented compressed air injuries as a rare cause of orbital emphysema and pneumocephalus in the absence of concomitant skull fractures leading to various injuries. CASE PRESENTATION: We illustrate here a 12-year-old boy who presented with painless left eye swelling following an accidental compressed air blast injury. On examination, he exhibited mild bilateral visual acuity impairment. The left eyelids, periorbital region, and cheeks were swollen, with swelling extending to the jaw with palpable crepitations. Ocular motility of the left eye was restricted in all directions. Slit lamp examination revealed subconjunctival hemorrhage, air bubbles, and chemosis, while the cornea, anterior chamber and lens were normal. Pupillary reactions were brisk. Fundus examination and intraocular pressure were normal. The right eye and adnexa were completely normal. The patient had no neurological symptoms. NCCT scan revealed left frontal and temporal subcutaneous emphysema, bilateral orbital emphysema, and multiple gas foci in the left masticator, parotid and carotid spaces, as well as in both parapharyngeal spaces. Pneumocephalus was noted in the left temporal lobe, along the left cavernous sinus and parasellar region without bony fractures. The patient underwent surgical exploration of the sclera of the left globe under general anesthesia to exclude the presence of a scleral wound under subconjunctival hemorrhage and air bubbles and he was free. The patient was managed conservatively with instructions for bed rest, head elevation, and avoidance of the Valsalva maneuver. Gradual improvement was reported over follow-up, with the patient returning to normal after four weeks.
conclusionsBoth orbital emphysema and pneumocephalus can occur in rare instances without skull fractures. The symptoms can range from mild to life-threatening. Mild cases can be managed conservatively.
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