A 6-month-old male presents with left eye periorbital edema. His mother states that four days prior, the patient suffered an accidental “headbutt” from his older brother when the brother leaned backward and his head hit the patient around their left eye and forehead. The mother noticed immediate left eye periorbital edema and erythema. Since the injury, the patient’s left eye has progressively swollen shut and he is unable to spontaneously open the eye (see photo). She also noticed that the child cannot move the left eye when she forcibly opens his eyelids.
Your examination reveals a normal-appearing right eye with normal fixation and tracking behavior. However, the left eye has a complete ptosis and when you open the eyelid, you note poor tracking behavior, and a round, non-reactive, 4mm pupil with an rAPD. Additionally, the eye is exotropic and there is limited motility (ductions) in all directions as well as moderate proptosis and displacement of the globe inferiorly. Dilated fundus exam is notable only for possible mild pallor of the left optic disc. A CT scan of the head was performed at an outside hospital and was read as “Normal CT of the head”.
Case contributed by: Lucas W. Rowe, MD. Indiana University School of Medicine
Concerned , educational presentation thank you .
Siempre se aprende e refresca
Really insightful. What a refreashing way to relearn
very interesting way to refresh our clinical knowledge. Thank you !
Thanks for sharing the case
Thank u very much.
Very nice..
Thank you so much.
Thanks
Thank you so much
thank you . nice case presentation
Interesting case
Gracias por compartir un caso muy interesante, el uso de recursos tecnológicos que llevan a un diagnóstico preciso.
Thanks so much for the education.
It is very nicely presented case. Gives us important warnings points.
Thank you for sharing the case.
thanks! it is really helpful!
for me!
Thank you very much for this interesting case
Thnks for sharing. Very concise yet practical.
Interesting case, thank You
I thought it was related with injury. Interesting case. Thx
Very educative. Thank you
Thanks a lot for sharing this case, it’s interesting in differential diagnosis.
Thank you for excellent case.
V interesting case. Excellent learning
Well occupied learning and also good questions to answer I am highly appreciate it that
Good question
A challenging case and informative case presentation.
Thanks for sharing these types of scientific articles.
Interesting case and good learning notes. Thank you!
Quite interesting. The lesson to be learnt here is meticulous attention to history and clinical examinations. This was a 6 months old child that could bave been easily misdiagnosed.
Thanks to the contributor / Cybersight Team.
Very interesting case presentation one could learn from
Excellent case presentation and discussion.
Very interesting case presentation. Thank you
A GOOD WAY OF LEARNING AND UPDATE.
Very interesting case.
Thank you so much
Very interesting case.
Thank you for sharing.
Thanks
Educative & interesting, thanks.
Very interested case, thanks for sharing🌹🌹🌷🌷
Very educative!
Lo siento, no pude traducir al español, las opciones que puedo traducir lo veo súper importantes y enriquecedoras, me permiten fortalecer mis conocimientos y por ende mejor mis habilidades y mejor servicio a los pacientito. Gracias Orbis👏🏽❣
I love this! Quite educative
Thank you
Interesting and quite challenging questions but very educative.
Lo siento, no pude traducir al español, las opciones que puedo traducir lo veo súper importantes y enriquecedoras, me permiten fortalecer mis conocimientos y por ende mejor mis habilidades y mejor servicio a los pacientito. Gracias Orbis👏🏽❣
Lovely case study
Learnt a few as well
Very interesting case. Thank you very much
Very interesting case. Thank you very much
Thank you very much
Good case. Something we encounter in our clinic. Great practical learning points
Very interesting case, I still believe doing CT scan first, more easy, practical and available, also to exclude any bony erosion.
Thank you very much.
Nice case and very educative.
Very educative case. Thanks.
Thanks for this. Very much interested case.
Thank you!
Very nice case to discuss
Thanks for sharing
Wow, interesting, aspiring to give right answer, this is kind of Self Evaluation
Thanks for sharing and give us a chance to learn!
Very knowledgeable scenario case… Hope for more cases like this to do our command on disease diagnosis… Thanks
Thank you for the case/palpation find à solid tumor in général/induration
Thanks
Very nice case presentation.
Thank you so much
This is very educative, thank you
Very well-presented and instructive
Thanks 🌷
I still think than the ultrasound is the first imaging that should be performed. It does not require sedation, it is quick, painless, and especially for rhabdomyosarcoma Ascan analysis is very accurate! MRI should also be performed, of course, but US gives you head start in quick organisation of further treatment without delay. The availability of MRI in different countries should be taken in consideration in this question!
Nevertheless, nice case!
Kind regards
Thanks
Such an open mind question
Very nice test and interested. I have learned alot n thanks very much.
Wow. Beautiful case. Missed the last diagnosis. It was educative
thanks for this knowledge
Thank you very much
This was really really amazing and useful
I am so happy, Thank you so much
good Quiz
How about injury before? Any correlation between injury and rhabdomysc?
The injury before can mislead you, that’s why you have to do investigations
Very interesting case report with MRI diagnostic findings.
All the salient points about Rhabdomyosarcoma are given for refreshing the knowledge about this tumour for the praticing ophthalmologists.
Thank you very much.
Thanks to share us kinds of case
And a good explanation about case