Indian Journal of Ophthalmology

: 2019  |  Volume : 67  |  Issue : 10  |  Page : 1737-

“Guitar pick sign” on MRI

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

Correspondence Address:
Dr. Venkatraman Indiran
32 Kumarapuram Chromepet, Chennai - 600 044, Tamil Nadu

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

How to cite this URL:
Indiran V. “Guitar pick sign” on MRI. Indian J Ophthalmol [serial online] 2019 [cited 2020 Aug 12 ];67:1737-1737
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Full Text

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}{Figure 2}

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

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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

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1Dalley RW, Robertson WD, Rootman J. Globe tenting: A sign of increased orbital tension. AJNR Am J Neuroradiol 1989;10:181-6.
2Theoret 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.
3Nguyen VD, Singh AK, Altmeyer WB, Tantiwongkosi B. Demystifying orbital emergencies: A pictorial review. Radiographics 2017;37:947-62.