To see views enlarged, click on the individual pictures...

This 10-year-old boy presents with acute proptosis.

This 10-year-old boy developed bilateral proptosis over a one week period. His vision and the eye examination are normal except for the proptosis, but he has some pain on movement of the eyes. He has also had some lethargy and vomiting. A week before this episode he had a mild upper respiratory infection. Prior to this happening the boy had been in excellent health.

1.	The test that would be most likely to provide a diagnosis in a case like this would be:
	a. orbital imaging b. chest X-ray c. complete blood count d. bone marrow biopsy e. none of the above
2.	The most likely diagnosis in this case is:
	a. ruptured dermoid cyst b. orbital cellulitis c. metastatic tumor d. idiopathic orbital inflammation (orbital pseudo tumor) e. there is an equal chance that it could be any of the above
3.	The patient had a dramatic initial response to oral and intravenous steroids indicating:
	a. the likely diagnosis b. nothing important c. that a very serious problem exists d. the need for an immediate biopsy e. a blood dyscrasia

For answers to the above, click here on or after January 25, 2011.