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

This question is really about reading one specific ultrasound clue correctly: calcification inside the mass.

1. Coats disease: Causes retinal detachment through leaking vessels and lipid rich subretinal fluid, but it does not form a calcified mass, so this does not match the scan.
2. Retinoblastoma: Grows fast, outstrips its blood supply, and deposits calcium within the tumor. A calcified, heterogenous subretinal mass with detachment in a young child is its classic ultrasound signature.
3. Toxocariasis: Produces an inflammatory granuloma from a larva, which is soft tissue, not a calcified mass.
4. Retinal tuberculoma: A rare granulomatous mass that also does not typically calcify on B scan.

Since calcification within an intraocular mass in a 2 year old is essentially specific for retinoblastoma, that is the diagnosis the scan points to.

Let's summarize:

• Retinal detachment alone can come from several childhood eye diseases.
• Calcification inside the mass is the deciding clue, and it means retinoblastoma.

So the most likely diagnosis is retinoblastoma.