Pediatric emergency medicine trisk 2681 2681

Clinical Recognition Intraorbital tumors may involve any of the tissues contained by the orbit including bone, muscle, soft tissue, and the globe itself Masses in these regions have a wide differential diagnosis, including infections (periorbital and orbital cellulitis), orbital myositis, benign germ cell tumors, or cystic lesions such as a dermoid cyst Retinoblastoma is the most common intraocular malignancy in children It occurs in in 23,000 births and is usually diagnosed by age Two-thirds of patients with retinoblastoma present with a white pupil (leukocoria) noted by parents This is the tumor as seen through the vitreous The most common malignancies affecting the bony orbit are LCH and neuroblastoma Presenting symptoms usually include proptosis and strabismus Vascular tumors including capillary hemangiomas of the orbit may present with red or purple nodular lid lesions or proptosis Masses in the aerodigestive tract may be benign, infectious, or reactive in etiology Regardless of the tissue of origin, these masses usually present with symptoms related to their anatomic position Oropharyngeal tumors such as with Burkitt lymphoma can cause snoring and obstructive sleep apnea as well as chronic otitis media and unilateral tonsillar hypertrophy Gingival hypertrophy may be a sign of a monocytic leukemia LCH or Burkitt lymphoma of the mandible can present with loose teeth Rhabdomyosarcoma of the salivary or parotid gland often presents with pain or a facial mass Malignant tumors of the nose, nasopharynx, and sinuses can present with purulent or bloody rhinorrhea, epistaxis, or sinusitis Nasopharyngeal carcinoma tends to have a long duration of symptoms before diagnosis because symptoms are rarely specific Malignant tumors of the sinuses and base of the skull can present with cranial neuropathies such as deviation of the eyes due to compression of the cranial nerves by the tumor Rhabdomyosarcoma of the middle ear can present with persistent otitis, pain, or cranial neuropathy The external ear canal can be affected by LCH leading to otorrhea and otitis externa Neck masses due to benign congenital anomalies such as branchial cleft cysts or cystic hygromas may grow suddenly as a result of infection or bleeding Lymphadenopathy in children is common and usually benign It is most commonly either reactive or infectious in etiology Bilateral nodes may be associated with viral infections such as EBV or cytomegalovirus (CMV) Unilateral lymphadenopathy or lymphadenitis, especially in infants and young children, may be associated with Staphylococcus aureus or group A streptococcus infections Even lymph node enlargement with a chronic time course is still most likely infectious (e.g., mycobacteria, cat-scratch disease, toxoplasma) Lymph nodes can appear large even without infection or malignancy, as observed in Castlemans, Kikuchis, and Rosai– Dorfman syndromes Enlarged lymph nodes in the neck due to malignancy can be