Decoding “guitar pick sign” in COVID-19–associated mucormycosis: A case series

Abstract

“Guitar pick sign,” also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19–associated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.

Keywords

• coronavirus disease-19
• guitar pick sign
• non-salvageable vision loss
• orbital mucormycosis
• posterior globe tenting