What do you see?

Describe the above set of images. This represents a leading cause of blindness among working-age Americans.

Your next phone call...

First, my apologies for taking so long between posts. I have been spending long hours on my medicine Sub-I on the Heme/Onc service...which provides a perfect segue into the discussion of the previous image.

This image is a set of color fundus photos showing the left eye. Most remarkable finding in this image are the very prominent hemorrhages. There are both subhyaloid and intraretinal hemorrhages. Several of the intraretinal hemorrhages display white centers, also known by there eponym, "roth's spots."

Roth's spots are often discussed as findings where a patient has septic emboli from subacute bacterial endocarditis (SBE). In reality, though, they are not a specific finding and are associated with many systemic diseases including diabetic retinopathy and various hematologic malignancies.

In addition, this retina shows extremely globular subhyaloid hemorrhages, that show fluid level from the settling of red blood cells. In these subhyaloid areas, there also appears to be large amounts of serous fluid. This picture is very suspicious for bleeding in the setting of severe thrombocytopenia.

In this patient, the acute presentation along with young age, when combined with the sheer extent of pathology raises a red flag for some kind of hematologic process. Key retinal findings are the Roth's spots and macular subhyaloid hemorrhages. In this case, one must quickly rule out an acute leukemia, and a call to a pediatric hematologist/oncologist must be a first priority. The most common pediatric leukemia is Acute lymphoblastic leukemia, which may present in the eye similarly to this patient. http://www.aao.org/theeyeshaveit/optic-fundus/retinal-hemorrhages.cfm

The workup for this patient is ongoing. He was found to have aplastic anemia of unknown (as of yet) etiology. Stay tuned for updates.