Retinoblastoma physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [[retinoblastoma]] usually appear normal. [[Physical examination]] of patients is usually remarkable for [[leukocoria]], [[strabismus]], and [[proptosis]], particularly in advanced cases.
[[Patient|Patients]] with retinoblastoma usually appear normal. [[Physical examination]] of [[Patient|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 acuity]], unilateral [[mydriasis]], [[rubeosis iridis]], [[vitreous]] [[hemorrhage]], and findings of intrinsic [[calcification]] on fundoscopic examination.
Other findings on [[physical examination]] of retinoblastoma include [[anisocoria]], [[orbital cellulitis]], [[hyphema]], [[heterochromia iridis]], poor [[visual acuity]], unilateral [[mydriasis]], [[rubeosis iridis]], [[vitreous]] [[hemorrhage]], and findings of intrinsic [[calcification]] on [[Fundoscopy|fundoscopic examination]].
==Physical Examination==
==Physical Examination==
[[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.
*[[Child|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>
*[[Child|Children]] may appear [[Cachexia|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 usually within normal limits.
*[[Vital signs]] of [[Patient|patients]] with retinoblastoma are usually within normal limits.
===Skin===
===Skin===
* Skin examination of patients with [[retinoblastoma]] is usually normal.
* [[Skin]] [[Physical examination|examination]] of [[Patient|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>
*[[Hypertelorism]] in case of concurrent [[13q deletion syndrome]]<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>
Initial observation may indicate:
*[[Leukocoria]] (white reflex or cat's [[eye]] reflex)
*[[Hypertelorism]] in case of concurrent [[13q deletion syndrome]]
*[[Strabismus]] or when both [[Eye|eyes]] do not look to the same direction
*[[Leukocoria]] (white reflex or cat's eye reflex)
*[[Periorbital edema|Periorbital swelling]]
*[[Strabismus]] or when both eyes do not look to the same direction
*Periorbital swelling
*[[Anisocoria]] or inequality of [[pupils]]
*[[Anisocoria]] or inequality of [[pupils]]
*[[Proptosis]]  
*[[Proptosis]]  
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Assessing the [[visual acuity]] may indicate poor vision.<br>
* Decreased [[visual acuity]]  
Examination of via slit lamp may indicate:
* [[Slit lamp]] [[examination]] may show:
*[[Orbital cellulitis]]
 
*[[Hyphema]]
**[[Orbital cellulitis]]
*[[Heterochromia iridis]]
**[[Hyphema]]
*[[Rubeosis iridis]]
**[[Heterochromia iridis]]
*Red, painful eye with [[glaucoma]]
**[[Rubeosis iridis]]
*[[Vitreous hemorrhage]]
**Red, painful [[eye]] with [[glaucoma]]
[[Ophthalmoscopy|Funduscopic examination]] of [[retinoblastoma]] may indicate:
**[[Vitreous hemorrhage]]
*In smaller [[tumors]]:
 
**Round glazed elevations of the [[retina]] with gray-white hew which develop surrounding serous [[retinal detachments]]
* [[Ophthalmoscopy|Funduscopic examination]] may show:
*In larger [[tumors]]:
 
**Intrinsic [[calcification]] and a whiter color with seeding into the subretinal and or the [[vitreous]] space
** Small [[Tumor|tumors]]: Round glazed elevations of the [[retina]] with gray-white hew which develop surrounding the serous [[retinal detachments]]
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>
**Large [[Tumor|tumors]]: Intrinsic [[calcification]] and a white color with seeding into the [[Retina|subretinal]] and or the [[vitreous]] space
*[[Hypertelorism]]
 
*Flat nasal bridge
* [[Patient|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>
*Small mouth and nose
 
*High arched or [[cleft palate]]
**[[Hypertelorism]]
*[[Micrognathia]]
**Flat [[nasal bridge]]
*[[Microcephaly]]  
**Small [[mouth]] and [[nose]]
**High arched or [[cleft palate]]
**[[Micrognathia]]
**[[Microcephaly]]  
{|
{|
|[[image:Retinoblastoma-fundoscopy-photo.jpeg|thumb|400px|Retinoblastoma funduscopy, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9460]]
|[[image:Retinoblastoma-fundoscopy-photo.jpeg|thumb|400px|Retinoblastoma [[fundoscopy]], Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9460]]
<br style="clear:left" />
<br style="clear:left" />
|-
|-
|}
|}
===Neck===
===Neck===
* Neck examination of patients with [[retinoblastoma]] is usually normal.
* [[Neck]] [[Physical examination|examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Lungs===
===Lungs===
* [[Pulmonary examination]] of patients with [[retinoblastoma]] is usually normal.
* [[Pulmonary examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Heart===
===Heart===
* [[Cardiovascular]] examination of patients with [[retinoblastoma]] is usually normal.
* [[Cardiovascular]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Abdomen===
===Abdomen===
* [[Abdominal examination]] of patients with [[retinoblastoma]] is usually normal.
* [[Abdominal examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Back===
===Back===
* Back examination of patients with [[retinoblastoma]] is usually normal.
* [[Human back|Back]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [[retinoblastoma]] is usually normal.
* [[Genitourinary system|Genitourinary]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [[retinoblastoma]] is usually normal.
* [[Neuromuscular]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Extremities===
===Extremities===
* Extremities examination of patients with [[retinoblastoma]] is usually normal.
* [[Limb (anatomy)|Extremities]] [[examination]] of [[Patient|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 [[Hand|palms]] and a 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==
==References==

Revision as of 19:56, 11 June 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 on physical examination of retinoblastoma include anisocoria, orbital cellulitis, hyphema, heterochromia iridis, poor visual acuity, unilateral mydriasis, rubeosis iridis, vitreous hemorrhage, and findings of intrinsic calcification on fundoscopic examination.

Physical Examination

General Appearance

Vital Signs

Skin

HEENT

leukocoria, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9462


Retinoblastoma fundoscopy, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9460


Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ MacKay CJ, Abramson DH, Ellsworth RM (March 1984). "Metastatic patterns of retinoblastoma". Arch. Ophthalmol. 102 (3): 391–6. PMID 6703986.
  2. ↑ 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.
  3. ↑ Clark, Robin D.; Avishay, Stefanie G. (2015). "Retinoblastoma: Genetic Counseling and Testing": 77–88. doi:10.1007/978-3-662-43451-2_8.

​

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