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   Table of Contents      
Year : 2019  |  Volume : 67  |  Issue : 10  |  Page : 1737

“Guitar pick sign” on MRI

Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication23-Sep-2019

Correspondence Address:
Dr. Venkatraman Indiran
32 Kumarapuram Chromepet, Chennai - 600 044, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_404_19

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How to cite this article:
Indiran V. “Guitar pick sign” on MRI. Indian J Ophthalmol 2019;67:1737

How to cite this URL:
Indiran V. “Guitar pick sign” on MRI. Indian J Ophthalmol [serial online] 2019 [cited 2020 Jul 4];67:1737. Available from: http://www.ijo.in/text.asp?2019/67/10/1737/267446

A 60-year-old male who presented with right orbital pain, swelling, and watering for 5 days showed right proptosis, redness, swelling, restricted extraocular movements and no light perception. Magnetic resonance imaging orbits showed extensive right retrobulbar inflammation and T2 hypointense signal causing significant proptosis and stretching of the optic nerve which in turn deformed the posterior globe into a characteristic “guitar pick” shape [Figure 1] and [Figure 2]. Surgical debridement showed Aspergillus infection, following which antifungal treatment was instituted. Posterior globe tenting also called as “guitar pick” sign is usually seen in orbital trauma and acute inflammatory/infective pathologies.[1],[2],[3] Significant proptosis stretches the optic nerve which tethers the globe and damages the optic nerve either due to acute stretching or acute ischemia. Posterolateral canthotomy and inferior cantholysis can relieve posterior globe tenting in cases of retrobulbar haemorrhage.[2] Aggressive surgical debridement along with antifungal therapy is useful for treating fungal infections presenting with retrobulbar disease.[3] Drainage of orbital hematoma or abscess and bony wall decompression may also help. Identifying the “guitar pick” sign sonographically may add to the clinical examination and help decide whether to perform decompression. As “guitar pick” sign on imaging (especially when posterior angle is <120°) is associated with acute and permanent visual damage, it should prompt urgent treatment.[1],[2],[3]
Figure 1: MRI orbit axial section (a) shows posterior globe tenting (“guitar pick” sign) with significant retrobulbar inflammatory changes on the right side (white arrow). Coronal section (b) shows significant retrobulbar inflammatory changes on the right side (white arrow)

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Figure 2: MRI orbit sagittal section (a) shows posterior globe *** tenting (“guitar pick” sign) with significant retrobulbar inflammatory changes on the right side (white arrow). Sagittal section of left eye (b) shows normal posterior surface of globe and normal retrobulbar fat (white arrow)

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Informed Consent

Informed consent was obtained from individual participant included in the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Dalley RW, Robertson WD, Rootman J. Globe tenting: A sign of increased orbital tension. AJNR Am J Neuroradiol 1989;10:181-6.  Back to cited text no. 1
Theoret J, Sanz GE, Matero D, Guth T, Erickson C, Liao MM, et al. The “guitar pick” sign: A novel sign of retrobulbar hemorrhage. CJEM 2011;13:162-4.  Back to cited text no. 2
Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B. Demystifying orbital emergencies: A pictorial review. Radiographics 2017;37:947-62.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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