Raccoon eyes and the MIBG super scan: scintigraphic signs of neuroblastoma in a case of suspected child abuse

A case report of stage IV neuroblastoma which presented with periorbital swelling and ecchymosis originally misdiagnosed as facial trauma. The child soon developed a sinister pancytopenia, which following extensive investigations was revealed to be due to an underlying neuroblastoma. Periorbital ecchymosis associated with neuroblastoma is termed 'raccoon eyes' and is a diagnostic trap for the unwary.

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“…This case represents a classical presentation of this appearance. In the past this presentation has been mistaken for facial trauma [7,13].…”

Section: Discussionmentioning

confidence: 99%

Facial features of widespread neuroblastoma: a case report

Cliff

Newman

Malone

et al. 2001

Int J Paed Dentistry

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“…3,7 A 10-month-old infant, initially suspected to be a case of child abuse, was diagnosed with scintigraphic raccoon eyes due to neuroblastoma upon bone scan investigation. 8 Connective tissue disease causing capillary fragility can also mimic inflicted bruising. Inherited collagenopathies such as osteogenesis imperfecta and Ehlers-Danlos syndrome (EDS) can be falsely implicated as child abuse.…”

Section: Cutaneous Mimickers Of Physical Child Abusementioning

confidence: 99%

Cutaneous mimickers of physical child abuse: A brief overview

et al. 2022

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Child abuse is one of the medico-legal issues a physician may face during his/her clinical practice. It has devastating effects on both the child and family, especially psychological. If falsely identified as a child abuse case, it could result in detrimental consequences. Therefore, physicians must recognise and be able to rule out child abuse mimickers, which are often conditions that are mistakenly confused with true physical child abuse. Injuries like bruises and burns are common presentations and therefore it is important to consider cutaneous abuse mimics to avoid incorrect diagnosis of child abuse. This review article sheds light on the most common cutaneous conditions that can mimic physical child abuse, where patients present with patterns of various skin lesions that raise a suspicion of child abuse.

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“…Metastatic disease in cortical bone causes pain and limping as well as non-specific irritability in infants. Periorbital metastases may cause proptosis or orbital ecchymosis ("raccoon eyes") and resemble facial trauma [66]. Metastatic neuroblastoma deposits may occur in infants as subcutaneous nodules with distinct bluish discoloration known as "blueberry muffin" spots.…”

Section: Clinical Presentationmentioning

confidence: 99%

Current aspects of biology, risk assessment, and treatment of neuroblastoma

Haase

Pérez

Atkinson

1999

Semin. Surg. Oncol.

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Neuroblastoma is one of the most intensely studied solid malignancies that affect the pediatric age groups; its clinical presentation, treatment strategies and ultimate prognosis vary greatly. The biologic and genetic character of each tumor has an important impact on disease behavior, and clinical staging now incorporates these factors to generate an overall therapy plan. The clinical presentation of neuroblastoma is related to primary tumor location, production of metabolically active substances, and the presence of metastatic disease. There are also prognostically important associated syndromes including opsoclonus-myoclonus, Horner's syndrome, neurofibromatosis, and a variety of other neurocristopathies. The histologic features of the tumor are of prognostic significance and are utilized in treatment stratification. The International Neuroblastoma Staging System (INSS) has unified classic clinical staging. Features at diagnosis and those determined by initial operation are combined with biologic prognostic factors to achieve risk group assignment for virtually all patients. There are groups of children in which limited therapy is curative and intermediate-risk situations where standard multimodality treatment provides favorable outcomes. Unfortunately, there are many patients with high-risk disease that require intensive strategies, but success is still limited. It is in these most resistant patients that innovative approaches are being undertaken and novel strategies are being investigated. Semin. Surg. Oncol. 16:91-104, 1999.

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Raccoon eyes and the MIBG super scan: scintigraphic signs of neuroblastoma in a case of suspected child abuse

Cited by 23 publications

References 6 publications

Facial features of widespread neuroblastoma: a case report

Facial features of widespread neuroblastoma: a case report

Cutaneous mimickers of physical child abuse: A brief overview

Current aspects of biology, risk assessment, and treatment of neuroblastoma

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