Medical Case

NAME : RAFIE LUGASSEKTI

NIM : P1337430216038
CLASS : 1B
 Retinoblastoma is a cancer that starts in the retina, the very back part
of the eye. It is the most common type of eye cancer in children.
Rarely, children can have other kinds of eye cancer, such as
medulloepithelioma, which is described briefly below, or melanoma
ANATOMY
About the eye
The main part of the eye is the eyeball (also known as the globe), which is filled with a
jelly-like material called vitreous humor. The front of the eyeball has a clear lens with an
iris (the colored part of the eye that acts like a camera shutter), which allows light to
enter the eye and focuses it on the retina.

The retina is the inner layer of cells in the back of the eye. It is made up of special nerve
cells that are sensitive to light. These light-sensing cells are connected to the brain by
the optic nerve, which runs out the back of the eyeball. The pattern of light (image) that
reaches the retina is sent through the optic nerve to an area of the brain called
the visual cortex, allowing us to see.

https://www.cancer.org/cancer/retinoblastoma/about/what-is-retinoblastoma.html
Retinoblastomas nearly always occur in young children. They are often found when a
parent or doctor notices a childs eye looks unusual.
1. White pupillary reflex
This is the most common early sign of retinoblastoma. Normally when you shine a light in
the eye, the pupil (the dark spot in the center of the eye) looks red because of the blood
vessels in the back of the eye. In an eye with retinoblastoma, the pupil often appears
white or pink instead, which is known as a white pupillary reflex (or leukocoria). This
white glare of the eye may be noticed by a parent after a flash photograph is taken,
especially if the pupils are different colors. It also might be noted by the childs doctor
during a routine eye exam.
2. Lazy eye
Sometimes the eyes dont appear to look in the same direction, a condition often called
lazy eye. (Doctors call this strabismus.) There are many possible causes of this in children.
Most of the time lazy eye is caused by a mild weakness of the muscles that control the
eyes, but it can also be caused by retinoblastoma.
Other possible signs and symptoms
1. Less common signs and symptoms of retinoblastoma include:
2. Vision problems
3. Eye pain
4. Redness of the white part of the eye
5. Bleeding in the front part of the eye
6. Bulging of the eye
7. A pupil that doesnt get smaller when exposed to bright light
8. A different color in each iris (the colored part of the eye)
9. Many of these signs and symptoms are more likely to be caused by something other
than retinoblastoma. Still, if your child has any of these, check with your childs doctor
so the cause can be found and treated, if needed.
EXAMS AND TESTS
The health care provider will perform a physical exam and ask about the
symptoms
Tests to diagnose Retinoblastoma

Chest x ray CT Scan MRI

A 2 year old female child was brought by parents to OPD with chief complaints of
White opacity in both eyes since birth.Poor vision in both eyes since birth.Forward
protrusion, redness and watering from right eye since 15 days. At that time, the
doctor he needed a rontgen examination that is x ray photographed Orbits
foramen and laboratory examination of the eye being processed.
 Preparation tools and materials
1. X-ray
2. IP size 18 x 24 cm
3. CR
4. Soft Bag
5. Marker
6. Grid
 Patient Preparation
Patient only removes objects that may disturb the radiographic image in order to
obtain optimal information and can be supportive for diagnosis.
Implementation of the examination
Projection Rhese Method AP
Position of patient
Patient supine
Position of part
1. Rotate the patients head so that the MSP forms an angle of 53 degrees to the
plane of the IR
2. Adjust the AML perpendicular to the IR
3. Immobilize the patients head
4. Respiratio : Suspend
 Central Ray
1. Perpendicular to enter to uppermost orbit at its inferior and lateral quadrat.
2. Center the IR to the central ray.
 Because the patient is children. So use the Rhese method AP.
Projection shown:The optic canal on end and the optic foramen in the inferior
and lateral quadrant of the orbit.
Need examination CT-SCAN or MRI to explain more diagnose the retinoblastoma
1. Allen Andrew. 2003. Merrills Atlas of Radiographic Positions and Radiologic
Procedures Ed 10. St, Louis Missouri. Mosby Elsevier
2. https://www.cancer.org/cancer/retinoblastoma/about/what-is-
retinoblastoma.html