Globe Lesions in Children: Quick and Dirty

• Retinopathy of prematurity (ROP): Abnormal vascular development due to prolonged oxygen therapy leads to hemorrhage. Usually bilateral. Increased attenuation in a small globe associated with retinal detachment.
• Persistent hyperplastic primary vitreous (PHPV): Persistence of embryonic vitreous vascualrity leads to hemorrhage. Usually unilateral. Increased attenuation in a small globe associated with cataracts and retinal detachment. Hyperintense on T1 and T2.
• Retinoblastoma (Rb): Most common globe tumor in children, with almost all cases presenting before age 5. Majority unilateral. Most often has calcium. Hyperintense on T1 and hypointense on T2. Avid enhancement.
• Retinal astrocytoma: Look for signs of tuberous sclerosis or neurofibromatosis type 1. Most often has calcium.
• Coats disease: Subretinal exudates with V-shaped retinal detachment in boys. Contrary to the oversimplification of the chart, the globe is actually smaller than in patients with retinoblastoma. No tumor mass. Enhancement of the detached leaves of the retina. Hyperintense on T1 and T2.
• Toxocariasis: Due to hypersensitivity to the larva. Patients have a history of contact with dogs or cats. Can calcify if chronic. Traction detachment of the retina. Isointense on T1 and hyperintense on T2.

References

• Smirniotopoulos JG, Bargallo N, Mafee MF. Differential diagnosis of leukokoria: radiologic-pathologic correlation. Radiographics. 1994 Sep;14(5):1059-79.
• Galluzzi P, Venturi C, Cerase A, Vallone IM, Bracco S, Bardelli AM, Hadjistilianou T, Gennari P, Monti L, Filosomi G. Coats disease: smaller volume of the affected globe. Radiology. 2001 Oct;221(1):64-9.