Retinoblastoma physical examination: Difference between revisions
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Other findings in physical examination of retinoblastoma include [[anisocoria]], [[orbital cellulitis]], [[hyphema]], [[heterochromia iridis]], poor visual acquity, unilateral [[mydriasis]], [[rubeosis iridis]], vitreous [[hemorrhage]], and findings of a chalky white-gray retinal mass on fundoscopic examination. | Other findings in physical examination of retinoblastoma include [[anisocoria]], [[orbital cellulitis]], [[hyphema]], [[heterochromia iridis]], poor visual acquity, unilateral [[mydriasis]], [[rubeosis iridis]], vitreous [[hemorrhage]], and findings of a chalky white-gray retinal mass on fundoscopic examination. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with retinoblastoma is usually remarkable for leukocoria, strabismus, and proptosis, particularly in advanced cases. | [[Physical examination]] of patients with [[retinoblastoma]] is usually remarkable for [[leukocoria]], [[strabismus]], and [[proptosis]], particularly in advanced cases. | ||
===General Appearance=== | ===General Appearance=== | ||
*Children with retinoblastoma are generally well-appearing. | *Children with [[retinoblastoma]] are generally well-appearing. | ||
*Children may appear cachectic in advanced cases.<ref name="pmid6703986">{{cite journal |vauthors=MacKay CJ, Abramson DH, Ellsworth RM |title=Metastatic patterns of retinoblastoma |journal=Arch. Ophthalmol. |volume=102 |issue=3 |pages=391–6 |date=March 1984 |pmid=6703986 |doi= |url=}}</ref> | *Children may appear [[cachectic]] in advanced cases.<ref name="pmid6703986">{{cite journal |vauthors=MacKay CJ, Abramson DH, Ellsworth RM |title=Metastatic patterns of retinoblastoma |journal=Arch. Ophthalmol. |volume=102 |issue=3 |pages=391–6 |date=March 1984 |pmid=6703986 |doi= |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Vital signs of patients with retinoblastoma is | *[[Vital signs]] of patients with [[retinoblastoma]] is usually within normal limits. | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with retinoblastoma is usually normal. | * Skin examination of patients with [[retinoblastoma]] is usually normal. | ||
===HEENT=== | ===HEENT=== | ||
HEENT examination of patients with retinoblastoma is usually normal except for eye examination which may include following abnormal findings:<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189 }} </ref> | HEENT examination of patients with [[retinoblastoma]] is usually normal except for [[eye examination]] which may include following abnormal findings:<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189 }} </ref> | ||
*Hypertelorism in case of concurrent 13q deletion syndrome | Initial observation may indicate: | ||
*[[Hypertelorism]] in case of concurrent [[13q deletion syndrome]] | |||
*[[Leukocoria]] (white reflex or cat's eye reflex) | *[[Leukocoria]] (white reflex or cat's eye reflex) | ||
*[[Strabismus]] or when both eyes do not look to the same direction | *[[Strabismus]] or when both eyes do not look to the same direction | ||
*Periorbital swelling | *Periorbital swelling | ||
*[[Anisocoria]] or inequality of pupils | *[[Anisocoria]] or inequality of [[pupils]] | ||
*[[Proptosis]] | *[[Proptosis]] | ||
Assessing the visual acuity may indicate poor vision.<br> | Assessing the [[visual acuity]] may indicate poor vision.<br> | ||
Examination of via slit lamp may indicate: | Examination of via slit lamp may indicate: | ||
*[[Orbital cellulitis]] | *[[Orbital cellulitis]] | ||
| Line 31: | Line 32: | ||
*Red, painful eye with [[glaucoma]] | *Red, painful eye with [[glaucoma]] | ||
*[[Vitreous hemorrhage]] | *[[Vitreous hemorrhage]] | ||
Funduscopic examination of retinoblastoma may indicate: | [[Ophthalmoscopy|Funduscopic examination]] of [[retinoblastoma]] may indicate: | ||
*In smaller tumors: | *In smaller [[tumors]]: | ||
**Round glazed elevations of the retina with gray-white hew which develop surrounding serous retinal detachments | **Round glazed elevations of the [[retina]] with gray-white hew which develop surrounding serous [[retinal detachments]] | ||
*In larger tumors: | *In larger [[tumors]]: | ||
**Intrinsic calcification and a whiter color with seeding into the subretinal and or the vitreous space | **Intrinsic [[calcification]] and a whiter color with seeding into the subretinal and or the [[vitreous]] space | ||
Patients with 13q deletion syndrome may present with:<ref name="ClarkAvishay2015">{{cite journal|last1=Clark|first1=Robin D.|last2=Avishay|first2=Stefanie G.|title=Retinoblastoma: Genetic Counseling and Testing|year=2015|pages=77–88|doi=10.1007/978-3-662-43451-2_8}}</ref> | Patients with [[13q deletion syndrome]] may present with:<ref name="ClarkAvishay2015">{{cite journal|last1=Clark|first1=Robin D.|last2=Avishay|first2=Stefanie G.|title=Retinoblastoma: Genetic Counseling and Testing|year=2015|pages=77–88|doi=10.1007/978-3-662-43451-2_8}}</ref> | ||
*Hypertelorism | *[[Hypertelorism]] | ||
*Flat nasal bridge | *Flat nasal bridge | ||
*Small mouth and nose | *Small mouth and nose | ||
*High arched or cleft palate | *High arched or [[cleft palate]] | ||
*Micrognathia | *[[Micrognathia]] | ||
*Microcephaly | *[[Microcephaly]] | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with retinoblastoma is usually normal. | * Neck examination of patients with [[retinoblastoma]] is usually normal. | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with retinoblastoma is usually normal. | * [[Pulmonary examination]] of patients with [[retinoblastoma]] is usually normal. | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with retinoblastoma is usually normal. | * [[Cardiovascular]] examination of patients with [[retinoblastoma]] is usually normal. | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with retinoblastoma is usually normal. | * [[Abdominal examination]] of patients with [[retinoblastoma]] is usually normal. | ||
===Back=== | ===Back=== | ||
* Back examination of patients with retinoblastoma is usually normal. | * Back examination of patients with [[retinoblastoma]] is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with retinoblastoma is usually normal. | * Genitourinary examination of patients with [[retinoblastoma]] is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with retinoblastoma is usually normal. | * Neuromuscular examination of patients with [[retinoblastoma]] is usually normal. | ||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with retinoblastoma is usually normal. | * Extremities examination of patients with [[retinoblastoma]] is usually normal. | ||
*Simian crease in the palms and broad thumb may be present in 13q deletion syndrome. | *Simian crease in the palms and broad thumb may be present in [[13q deletion syndrome]]. | ||
*A thorough systemic examination is important as a pre-requisite for general anesthesia, as well as to rule out 13q deletion syndrome. | *A thorough systemic examination is important as a pre-requisite for [[general anesthesia]], as well as to rule out [[13q deletion syndrome]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
| |||
[[Category:Primary care]] | [[Category:Primary care]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Revision as of 17:48, 13 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Sahar Memar Montazerin, M.D.[3]
Overview
Patients with retinoblastoma usually appear normal. Physical examination of patients is usually remarkable for leukocoria, strabismus, and proptosis, particularly in advanced cases. Other findings in physical examination of retinoblastoma include anisocoria, orbital cellulitis, hyphema, heterochromia iridis, poor visual acquity, unilateral mydriasis, rubeosis iridis, vitreous hemorrhage, and findings of a chalky white-gray retinal mass on fundoscopic examination.
Physical Examination
Physical examination of patients with retinoblastoma is usually remarkable for leukocoria, strabismus, and proptosis, particularly in advanced cases.
General Appearance
- Children with retinoblastoma are generally well-appearing.
- Children may appear cachectic in advanced cases.[1]
Vital Signs
- Vital signs of patients with retinoblastoma is usually within normal limits.
Skin
- Skin examination of patients with retinoblastoma is usually normal.
HEENT
HEENT examination of patients with retinoblastoma is usually normal except for eye examination which may include following abnormal findings:[2]
Initial observation may indicate:
- Hypertelorism in case of concurrent 13q deletion syndrome
- Leukocoria (white reflex or cat's eye reflex)
- Strabismus or when both eyes do not look to the same direction
- Periorbital swelling
- Anisocoria or inequality of pupils
- Proptosis
Assessing the visual acuity may indicate poor vision.
Examination of via slit lamp may indicate:
- Orbital cellulitis
- Hyphema
- Heterochromia iridis
- Rubeosis iridis
- Red, painful eye with glaucoma
- Vitreous hemorrhage
Funduscopic examination of retinoblastoma may indicate:
- In smaller tumors:
- Round glazed elevations of the retina with gray-white hew which develop surrounding serous retinal detachments
- In larger tumors:
- Intrinsic calcification and a whiter color with seeding into the subretinal and or the vitreous space
Patients with 13q deletion syndrome may present with:[3]
- Hypertelorism
- Flat nasal bridge
- Small mouth and nose
- High arched or cleft palate
- Micrognathia
- Microcephaly
Neck
- Neck examination of patients with retinoblastoma is usually normal.
Lungs
- Pulmonary examination of patients with retinoblastoma is usually normal.
Heart
- Cardiovascular examination of patients with retinoblastoma is usually normal.
Abdomen
- Abdominal examination of patients with retinoblastoma is usually normal.
Back
- Back examination of patients with retinoblastoma is usually normal.
Genitourinary
- Genitourinary examination of patients with retinoblastoma is usually normal.
Neuromuscular
- Neuromuscular examination of patients with retinoblastoma is usually normal.
Extremities
- Extremities examination of patients with retinoblastoma is usually normal.
- Simian crease in the palms and broad thumb may be present in 13q deletion syndrome.
- A thorough systemic examination is important as a pre-requisite for general anesthesia, as well as to rule out 13q deletion syndrome.
References
- ↑ MacKay CJ, Abramson DH, Ellsworth RM (March 1984). "Metastatic patterns of retinoblastoma". Arch. Ophthalmol. 102 (3): 391–6. PMID 6703986.
- ↑ Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS; et al. (2012). "Retinoblastoma". Singapore Med J. 53 (2): 128–35, quiz 136. PMID 22337189.
- ↑ Clark, Robin D.; Avishay, Stefanie G. (2015). "Retinoblastoma: Genetic Counseling and Testing": 77–88. doi:10.1007/978-3-662-43451-2_8.