Peds Ophtho Case 1: Case Continued…

Peds Ophtho Case 1 Index

Answer: The fundoscopic exam of the right eye reveals a cream colored well-circumscribed intraocular mass with smaller adjacent mass inferiorly.  Therefore, the best next step is to obtain imaging, more specifically MRI of the brain and orbits.

Though genetic testing could be helpful for confirming the diagnosis, it would not be the next best step. Similarly, bone scan and lumbar puncture would be helpful if suspecting metastasis but imaging would still take precedence. 

Fine needle aspiration biopsy of any intraocular mass concerning for malignancy is not recommended due to increased risk of seeding. Serology would be useful for detecting toxocariasis. However, toxocariasis would not present with the above dilated fundoscopy findings. 

You order an MRI brain and orbits. An image is shown below:

RB MRI radiopaedia

Case courtesy of Radswiki, from the case “Retinoblastoma.” ID 11877

The radiology report reads:
“MRI Brain: There is a well circumscribed intraocular mass in right posterior chamber.

What other condition is associated with the most likely diagnosis? Pick 1 before moving on.
Ewing disease
Osteosarcoma 
 
Von Hippel Lindau
Li Fraumeni Syndrome
 
Wilms’ Tumor
 

If the patient presented with unilateral leukocoria and ophthalmologic examination showed lens opacity, what would be the most likely diagnosis?
Congenital cataract
Retinopathy of Prematurity
 
Corneal Scar
Retinoblastoma
 
Coats disease
 

Coats D
Above Image Credit: © 2021 American Academy of Ophthalmology

If the patient was 7 years old and an ophthalmologic examination revealed a yellow-white pupillary reflex along with the fundoscopic exam shown above, what would be the most likely diagnosis?
Congenital cataract
Retinopathy of Prematurity
 
Corneal Scar
Retinoblastoma
 
Coats disease
 

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Peds Ophtho Case 1 Index
Peds Ophtho Case 1: Introduction
Peds Ophtho Case 1: Physical Exam
Peds Ophtho Case 1: Ophtho Visit