Diagnostic Sonography • B-Scan Eye Pathology Atlas
Retinoblastoma
A structured ocular ultrasound case collection covering sonographically recognizable retinoblastoma patterns, with emphasis on intraocular mass morphology, calcification, retinal involvement, vitreous abnormalities and associated retinal detachment.
Retinoblastoma — Sonographic Morphology Index
Chapter 01 • Case Study
Classic Calcified Intraocular Retinoblastoma
01Clinical History
Child referred for evaluation of leukocoria with limited fundus visualization. B-scan is performed to identify an intraocular mass, characterize internal reflectivity and assess for calcification.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Mass | Solid intraocular mass, typically more echogenic than the vitreous. |
| Reflectivity | Focal very high reflectivity may correspond to intratumoral calcification. |
| Calcification | Highly reflective foci with posterior acoustic shadowing strongly support retinoblastoma in a child. |
| Location | Often arises from the retina and may project into the vitreous cavity. |
| Assessment | Document tumor dimensions and examine the remainder of the globe for associated retinal detachment or other abnormalities. |
04Ultrasound Report
A solid intraocular mass is demonstrated.
Multiple highly reflective intralesional foci with posterior acoustic shadowing are identified, compatible with calcification.
The sonographic appearance is highly suspicious for retinoblastoma in the appropriate clinical setting.
05Impression
Sonographic ImpressionIntraocular mass with intralesional calcific foci — sonographic appearance highly suspicious for retinoblastoma.
06Recommendation
Urgent ophthalmic oncology evaluation with comprehensive ocular examination and appropriate staging imaging, including MRI when indicated.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 02 • Case Study
Endophytic Retinoblastoma
01Clinical History
Child with suspected posterior segment tumor. B-scan is obtained to characterize a mass projecting toward the vitreous and to evaluate for associated vitreous or subretinal abnormalities.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Configuration | Retinal-based mass projecting inward toward the vitreous cavity. |
| Echogenicity | Usually echogenic relative to the vitreous. |
| Calcification | Internal hyperreflective foci may be present and can produce posterior shadowing. |
| Vitreous | Evaluate for echogenic material that may represent vitreous seeds, while recognizing that ultrasound cannot replace ophthalmic examination. |
| Extent | Document the tumor base, height and relationship to the posterior pole. |
04Ultrasound Report
A retinal-based intraocular mass projects toward the vitreous cavity.
Internal high-reflectivity foci are present; calcification should be correlated with the ultrasound appearance.
The vitreous cavity and remaining retina should be evaluated for associated abnormalities.
05Impression
Sonographic ImpressionRetinal-based intraocular mass with endophytic configuration; retinoblastoma is a major diagnostic consideration.
06Recommendation
Urgent specialist ophthalmic assessment with examination under anesthesia when clinically indicated and MRI for assessment of local extension.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 03 • Case Study
Exophytic Retinoblastoma with Subretinal Fluid
01Clinical History
Child with leukocoria and suspected posterior retinal tumor. B-scan is performed because fundus visualization is limited and to assess the relationship between the tumor and subretinal space.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Configuration | Tumor grows outward from the retina toward the subretinal space. |
| Subretinal fluid | Associated subretinal fluid or exudative retinal detachment may be demonstrated. |
| Calcification | Calcific foci may be present and are an important sonographic clue. |
| Retina | Assess the extent of associated retinal detachment and residual attached retina. |
| Differential | Coats disease and other causes of leukocoria may mimic some features; clinical correlation is essential. |
04Ultrasound Report
A retinal-based intraocular mass is demonstrated with associated subretinal fluid.
Internal reflective foci are present and should be assessed for calcification.
The findings require correlation with ophthalmic examination and dedicated imaging.
05Impression
Sonographic ImpressionRetinal-based intraocular mass with associated subretinal fluid/exudative retinal detachment; retinoblastoma should be urgently excluded.
06Recommendation
Prompt referral to an ocular oncology service. MRI is useful for evaluation of local extension when indicated.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 04 • Case Study
Retinoblastoma with Extensive Vitreous Seeding
01Clinical History
Child with suspected retinoblastoma and extensive vitreous abnormality. Dynamic B-scan is used to assess the globe when the tumor or vitreous cannot be adequately evaluated clinically.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Primary mass | Identify the underlying retinal-based mass whenever visible. |
| Vitreous echoes | Multiple echogenic foci or particulate material may be seen within the vitreous. |
| Calcification | Calcification within the primary tumor remains an important diagnostic clue. |
| Mobility | Vitreous echoes may show different movement from the solid tumor; dynamic assessment can help characterize the pattern. |
| Limitation | Ultrasound cannot reliably characterize or grade vitreous seeds; ophthalmic examination remains essential. |
04Ultrasound Report
A retinal-based intraocular mass is demonstrated with associated echogenic vitreous material.
Internal reflective foci within the mass are noted.
The sonographic findings are concerning for retinoblastoma with associated vitreous abnormality.
05Impression
Sonographic ImpressionIntraocular mass with associated vitreous echogenic material, concerning for retinoblastoma with vitreous seeding.
06Recommendation
Urgent ocular oncology evaluation and comprehensive retinal examination. Management and disease classification should be based on specialist ophthalmic assessment.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 05 • Case Study
Retinoblastoma with Retinal Detachment
01Clinical History
Child with advanced ocular symptoms and poor fundus visualization. B-scan is performed to characterize the tumor and determine the presence and extent of associated retinal detachment.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Tumor | Solid intraocular retinal-based mass. |
| Retinal detachment | Separate elevated retinal membrane or complex subretinal fluid may be demonstrated. |
| Mobility | The detached retinal component may demonstrate dynamic mobility distinct from the tumor. |
| Calcification | Intratumoral calcification may be identified as highly reflective foci with shadowing. |
| Extent | Document the extent of detachment and whether the posterior pole is involved. |
04Ultrasound Report
A solid intraocular mass is demonstrated.
Associated retinal detachment/subretinal fluid is identified.
Intralesional reflective foci are present and should be correlated for calcification.
05Impression
Sonographic ImpressionIntraocular mass with associated retinal detachment; findings are concerning for retinoblastoma in the appropriate clinical setting.
06Recommendation
Urgent ophthalmic oncology assessment. MRI should be considered for evaluation of optic nerve, orbital and intracranial extension when clinically indicated.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 06 • Case Study
Extensive Retinoblastoma with Near-Total Globe Involvement
01Clinical History
Child with markedly abnormal ocular appearance and inadequate fundus visualization. B-scan is performed to define the intraocular tumor burden and evaluate associated retinal or vitreous abnormalities.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Extent | Large intraocular mass occupying a substantial portion of the globe. |
| Reflectivity | Heterogeneous internal reflectivity may be present. |
| Calcification | Multiple hyperreflective calcific foci may be conspicuous. |
| Vitreous | Assess for associated echogenic material and hemorrhagic change. |
| Retina | Evaluate for retinal detachment and residual attached retina. |
04Ultrasound Report
Large heterogeneous intraocular mass occupying a substantial portion of the globe is demonstrated.
Multiple highly reflective intralesional foci are identified.
Associated retinal and vitreous abnormalities should be assessed on all available views.
05Impression
Sonographic ImpressionExtensive intraocular mass with internal hyperreflective foci, highly concerning for retinoblastoma.
06Recommendation
Urgent multidisciplinary ocular oncology evaluation with comprehensive clinical examination and MRI-based assessment of local extension when indicated.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Chapter 07 • Case Study
Retinoblastoma — Sonographic Assessment for Local Extension
01Clinical History
Known or strongly suspected retinoblastoma undergoing imaging assessment. B-scan is used to document intraocular tumor morphology, while MRI is used when evaluation of optic nerve, orbital or intracranial extension is required.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Intraocular tumor | Document location, dimensions, configuration and internal reflectivity. |
| Calcification | Identify hyperreflective foci and posterior acoustic shadowing. |
| Optic nerve | B-scan is not the preferred modality for definitive assessment of optic nerve invasion. |
| Orbit | Extraocular extension should not be excluded by a reassuring B-scan alone. |
| MRI correlation | MRI provides superior soft-tissue assessment of optic nerve, orbital and intracranial extension. |
04Ultrasound Report
Intraocular mass consistent with the known/suspected retinoblastoma is demonstrated.
Internal hyperreflective foci are documented.
Ultrasound findings should be correlated with ophthalmic examination and MRI when local extension assessment is required.
05Impression
Sonographic ImpressionSonographic documentation of intraocular retinoblastoma; ultrasound findings should be integrated with specialist ophthalmic examination and MRI for local staging when indicated.
06Recommendation
Refer to a specialized ocular oncology team. MRI is preferred for assessment of optic nerve and extraocular/intracranial extension.
07Learning Points
Document the tumor location, configuration and dimensions systematically.
Look specifically for intratumoral calcification and posterior acoustic shadowing.
Assess the vitreous and retina for associated abnormalities.
Do not use B-scan alone to exclude optic nerve or extraocular extension.
Educational Imaging References
This atlas uses the same visual structure as the supplied SonoAcademy Retinoschisis template, while the Retinoblastoma-specific medical content has been expanded from current ophthalmic imaging references.
- American Academy of Ophthalmology EyeWiki — Retinoblastoma
- 2025 Practical Guidelines on Imaging of Retinoblastoma
- Retinoblastoma: What the Neuroradiologist Needs to Know
Educational note: B-scan findings should be interpreted with ophthalmic examination and appropriate MRI/staging evaluation. Ultrasound alone should not be used to exclude optic nerve or extraocular extension.
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