Pediatric intraorbital wooden foreign body mimicking an orbital mass: Delayed diagnosis and imaging considerations on MRI.

Wooden intraorbital foreign bodies (IOFBs) are uncommon in children and may present a significant diagnostic challenge because their imaging appearance can mimic orbital neoplasms or inflammatory lesions, particularly when the trauma history is absent or unrecognized. We report the case of a 10-year-old boy presenting with progressive left orbital swelling and pain. Initial magnetic resonance imaging (MRI) demonstrated a rim-enhancing extraconal lesion with a central non-enhancing component and was initially interpreted as an orbital neoplasm, including a possible orbital schwannoma. No trauma history or external wound was identified, and the patient was subsequently lost to follow-up. Five months later, the patient re-presented with worsening swelling, purulent discharge, and a draining sinus tract. Repeat MRI demonstrated persistent thick peripheral enhancement with more conspicuous internal signal voids and interval development of a draining sinus tract, raising suspicion for retained wooden foreign bodies with an orbital abscess. Surgical exploration confirmed multiple retained wooden fragments within the extraconal orbital compartment. This case highlights the diagnostic pitfalls of wooden IOFBs on MRI and emphasizes the importance of maintaining a high index of suspicion for occult foreign bodies in children presenting with atypical orbital lesions, particularly when the clinical history is unclear. Careful sequence-by-sequence MRI interpretation and clinicoradiologic correlation are essential to facilitate timely diagnosis and prevent infectious complications.