A 26-year-old woman was referred for evaluation of a left orbital mass. At first the patient was unable to recall an injury to the left orbit. Further inquiry revealed that 3 nights prior she had been celebrating her first night out since having a baby and had enjoyed enough cocktails to cause her to fall while exiting a car. She awoke in the morning with what was described by the patient as a subconjunctival hemorrhage, ecchymosis around her left eye, and protrusion of the eye. This worsened over the course of 3 days, prompting her to go to the emergency department, from which she was then referred for oculoplastic evaluation to determine the etiology of the proptosis and diplopia in upgaze. Computed tomographic imaging demonstrated a left superior concave orbital soft tissue mass of homogeneous consistency extending from the level of the mid orbit to apex. Magnetic resonance imaging was also performed with similar findings. A differential diagnosis of hemorrhage, abscess, or lymphoma was considered. After 4 weeks of observation, the proptosis and diplopia resolved. The imaging findings of a concave orbital mass with homogeneous enhancement and associated proptosis is indicative of a subperiosteal fluid collection. The 2 most common etiologies for a mass with this classic configuration are abscess and hematoma. An abscess would be associated with adjacent sinusitis and signs and symptoms of orbital cellulitis. A hematoma would have presented as this case did with a history of trauma.
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