A 1-year-old boy presented with an 8-week history of bilateral periorbital ecchymosis (‘raccoon eyes’). Physical examination of the orbits, including neurological examination, was normal. A mass was palpated in the right upper quadrant. US and MRI of the abdomen demonstrated a large right adrenal mass with hepatic metastases. Orbital MRI showed bilateral periorbital metastatic infiltration with involvement of the meninges (Fig. 1).
Neuroblastoma is the most common extracranial solid tumour of childhood and accounts for 8–10% of all childhood cancers. Periorbital ecchymosis due to periorbital metastasis complicates approximately 5.4% of cases . It is probably related to obstruction of the palpebral vessels by tumour infiltration around the orbits. Periorbital ecchymosis is also a feature of skull trauma. Hence, diagnosis in these children can be delayed as this can arouse the suspicion of non-accidental injury .
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Bohdiewicz PJ, Gallegos E, Fink-Bennett D (1995) Raccoon eyes and the MIBG super scan: scintigraphic signs of neuroblastoma in a case of suspected child abuse. Pediatr Radiol 25(Suppl 1):S90–92
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Moran, D.E., Donoghue, V. Periorbital ecchymosis (‘raccoon eyes’) as the presenting feature of neuroblastoma. Pediatr Radiol 40, 1710 (2010). https://doi.org/10.1007/s00247-009-1467-3
- Public Health
- Physical Examination
- Solid Tumour
- Nuclear Medicine