acute strabism in toddler with some changes on MRI

[ladispoli]

My toddler girl had an episode of acute strabism in her left eye which I posted about 6 days ago. After that I took her to ER and she was admitted to rule/out any urgent causes of this sudden strabism (it is not fixed , and appears when she needs to concentrate on far objects. While in the hospital pediatric opthalmologist said her eye looks intact upon internal exam. He ordered an MRI to rule out other causes (like tumors, ect). Her brain looks WNL , with no masses or any encefalic changes. However, they found some vascular dialation of her left eye orbit in retrobullbular  region  and some adenoid hypotrophy. We need to follow up as outpatient with ultrasound of the orbits, and vision testing. What are some of the possible causes of this vascular dialtion and how serious is it? What should  I be worried about. They also tested her for TB which was negative. She was not febrile with this episode, and her only complaint is the pain in her eye. What other testing you would suggest? Thank you from my heart for any info!

[John C Hagan III, MD, FACS, FAAO]

I'm sorry I must have read it wrong. I do not know what a MDC is. My suggestion would be to make a list of your questions and call the office Monday and have the staff chase down the answers or make an appointment to go in to discuss.

GIven what you have told me it is extremely unlikely there is any tumor or malignancy.

JCHMD

[ladispoli]

Dear Dr. Hagan: You are absolutely right not to jump into bad conclusions, but it is so difficult when different doctors tell you different thing. First they told me it is nothing, then another doctor said he wants an u/s of the orbit.
You said in your last post to wait for an MRI . We have already had MRI and that's what it found -vascular dialation in the left orbit (her strabism is in the left), so I am sure this dialation is somehow related to her strabism. Also in the MRI result under the dialation portion it states -no probable pathologies after preforming MDC . What is MDC? A type of contrast? Does this mean after performing this MDC they don't think this vascular dialation is of pathologic  origin? I am so confused. Also if it was some kind of tumor (for example hemoangioma) wouldn't there be a mass, or it can be seen as just a vascular dialtion?They didn't find any kind of masses.  She actually has a hemoangioma on her back from birth, so it is likely that it can be in her other soft tissues like vessels. I am so sorry to bumbard you with all these questions, and thank you so much for volunteering your time. Julia

[John C Hagan III, MD, FACS, FAAO]

please DO NOT JUMP TO CONCLUSIONS. Most vascular abnormalities are NOT malignant.  Wait and see what the MRI shows.

JCHMD

[ladispoli]

This type of tumor is malignant(cancer)? What is the tx for it? How come they didn't say anything about possibility it might be a tumor? I live in Italy, and the doctors here are not very open and don't provide all the information to the patients like the doctors in US.

[John C Hagan III, MD, FACS, FAAO]

vascular dilation could represent abnomral blood vessesl, a tumor made of blood vessels (hemangiouma). Stay close to your treating tieam. They sound like they're on top of it.   Don't be surprised if the tests are all normal and she has accommodative esotrophia.

JCHMD