Illustrative CasesOrbital Cellulitis—When Computed Tomography Imaging Is Falsely ReassuringBasily, Arsany MD∗; Mansukhani, Sasha MBBS, MS†; Anzeljc, Andrew MD†; Gutierrez, Peter MD‡,§Author Information From the ∗Department of Pediatrics, Morehouse School of Medicine Departments of †Ophthalmology ‡Emergency Medicine §Pediatrics, Emory University School of Medicine, Atlanta, GA. Disclosure: The authors declare no conflict of interest. Reprints: Peter Gutierrez, MD, Department of Emergency Medicine, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329. Pediatric Emergency Care: January 2021 - Volume 37 - Issue 1 - p e48-e50 doi: 10.1097/PEC.0000000000001521 Buy Metrics Abstract An 8-year-old male presented to the pediatric emergency department with subjective fever, blurry vision, and left eye pain. On physical examination, there was mild left lower lid erythema and a subtle left eye elevation deficit. Computed tomography demonstrated preseptal soft tissue swelling without orbital involvement; however, there was varying amounts of paranasal sinus opacification. Despite the negative scan, a diagnosis of orbital cellulitis associated with sinusitis was made and treatment with intravenous antibiotics was initiated. A magnetic resonance imaging performed subsequently revealed orbital fat stranding and inferior rectus enlargement and enhancement near the orbital apex, indicating the presence of orbital cellulitis. This case demonstrates the utility of magnetic resonance imaging when initial computed tomography imaging is negative in patients with concern for orbital cellulitis. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.