Question

A 2 year old presented with leucocoria in the right eye since 2 months. On examination, a total retinal detachment was present in the same eye. Ultrasound B scan revealed a heterogenous subretinal mass with calcification, associated with a retinal detachment. The most likely clinical diagnosis is:

• A. Coats disease
• B. Retinoblastoma
• C. Toxocariasis
• D. Retinal tuberculoma

Hint:

Calcification on B scan inside a childhood intraocular mass points strongly to retinoblastoma.

Answer 1

The Correct Option is B

Step 1: List the causes of leucocoria in a young child.
Leucocoria (a white pupil reflex) in a 2 year old can come from retinoblastoma, Coats disease, persistent fetal vasculature, toxocariasis, or, rarely, a retinal tuberculoma. All of these can cause a retinal detachment, so the detachment alone does not point to one diagnosis.

Step 2: Focus on the key imaging clue.
The B scan shows a subretinal mass with calcification. Calcium deposits inside an intraocular mass in a young child are a hallmark finding of retinoblastoma, since the tumor cells outgrow their blood supply and deposit calcium as they break down.

Step 3: Check why the other diagnoses do not fit.
Coats disease causes a retinal detachment from leaking, abnormal retinal vessels and a build up of yellow lipid rich fluid under the retina, but it does not produce a calcified mass. Toxocariasis causes a granuloma from the larva, which is inflammatory tissue, again without calcification. Retinal tuberculoma is rare and also does not classically show calcification on B scan.

Step 4: Put the findings together.
A heterogenous subretinal mass with calcification and a retinal detachment in a young child is the classic ultrasound picture of retinoblastoma, the most common intraocular tumor of childhood.

Step 5: Final Answer.
The most likely diagnosis is retinoblastoma. \[ \boxed{\text{Retinoblastoma}} \]