Differential Diagnosis
The patient's presentation of persistent bruising, particularly around the eyes, along with a palpable abdominal mass and recent weight loss, suggests a serious underlying condition. The following differential diagnoses are considered:
Single most likely diagnosis
- Neuroblastoma: The presence of infraorbital ecchymoses (periorbital bruising) and a palpable abdominal mass is highly suggestive of neuroblastoma, a common extracranial solid tumor in children. The rapid, jerking movements of the eyes (opsoclonus) can also be associated with neuroblastoma, particularly in the context of an abdominal mass.
Other Likely diagnoses
- Wilms tumor: Although less likely than neuroblastoma given the specific combination of symptoms, Wilms tumor is another abdominal tumor that could present with a palpable mass and systemic symptoms like weight loss.
- Leukemia: Leukemia could explain the bruising and weight loss, but the presence of a distinct abdominal mass and opsoclonus is less typical for leukemia compared to neuroblastoma.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Child abuse: Given the history of the parents being divorced and the child spending weekends with the father, child abuse must be considered, especially with unexplained bruising. However, the specific pattern of bruising and the presence of an abdominal mass make this less likely.
- Immune thrombocytopenia: This condition could cause bruising but would not explain the abdominal mass or the opsoclonus.
Rare diagnoses
- Von Willebrand disease: A bleeding disorder that could cause bruising, but it would not account for the abdominal mass or the specific eye movements.
- Other rare tumors or conditions: There are numerous other rare conditions that could potentially explain some of the patient's symptoms, but they are less likely given the combination of findings presented.