Infant presents with persistent ecchymosis
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Here presents a case of a large heterogeneous right suprarenal mass concerning neuroblastoma and a small lesion in the liver suspicious for metastatic disease.

A 7-month-old boy was brought by his mother to the Eye Center for evaluation of persistent left eye redness and left upper eyelid bruising. The mother noticed these findings 6 to 8 weeks earlier after the patient was hit by a stuffed toy on the left side of his face. On examination, the patient was able to fix and follow objects with each eye. Slit lamp examination was notable for flat subconjunctival hemorrhage temporally in the left eye.

The orbital MRI revealed a mass in the greater wing of the left sphenoid bone with mass effect on the lateral rectus muscle and left temporal lobe (Figure 2). The cervical lymph nodes were enlarged. There were several enhancing facial soft tissue nodules and a small lytic calvarial lesion.

The patient was sent for abdominal ultrasound, which showed a large heterogeneous right suprarenal mass concerning neuroblastoma and a small lesion in the liver suspicious for metastatic disease. The patient underwent laparoscopic biopsy of the adrenal mass, which confirmed the diagnosis of neuroblastoma. He was sent for metaiodobenzylguanidine (MIBG) scintigraphy with future plans for systemic chemotherapy.

Management for neuroblastoma is highly variable depending on the risk stratification level of each patient. Treatment may include surgery, chemotherapy, radiation or observation alone.

Source: https://www.healio.com/ophthalmology/pediatrics-strabismus/news/print/ocular-surgery-news/{0db280dc-a36b-4ab3-9d82-bbc8008e693a}/infant-presents-with-persistent-ecchymosis
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