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Thursday, May 21, 2009

Image challenge from NEJM

image

What is the most likely diagnosis?

1. Amyloidosis

2. Craniopharyngioma

3. Leukemia

4. Neuroblastoma

5. von Willebrand's disease

 

ANSWER:

4. Neuroblastoma

The image shows bilateral periorbital ecchymosis with dysconjugate gaze; the sclera appear normal. The "raccoon eyes" appearance is characteristically associated with neuroblastoma metastases to the skull. The appearance is not consistent with the other choices.

 

 

Check this previous post for further information – Raccoon eyes.

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