Children with leukocoria should have an urgent ophthalmologic examination to help differentiate retinoblastoma from other possible etiologies such as congenital cataract, coloboma, idiopathic retinal detachment, and others Direct extension via the optic nerve into the meninges and spinal fluid is a possible but unlikely complication of the tumor Presentations are usually local and therefore cured by enucleation, but systemic chemotherapy, intra-arterial (ophthalmic artery) chemotherapy, cryotherapy, laser therapy, and insertion of radioactive plaques are all being explored to preserve vision Management of retinoblastoma hinges on the probability of useful vision in the affected eye Ophthalmology should be consulted early to determine if the patient’s visual acuity has already been affected by the mass and to plan the urgency of examination under anesthesia Management of intraorbital tumors may be possible on an outpatient basis, in conjunction with an experienced pediatric ophthalmologist, if the mass is unlikely to affect vision quickly or if vision is already profoundly impaired in the affected eye Management of other head and neck tumors can sometimes occur on an outpatient basis, in conjunction with a pediatric oncologist and a specialist, such as an oral surgeon or otorhinolaryngologist with expertise in the anatomic region of the tumor However, specific symptoms such as uncontrolled pain, difficulty maintaining hydration, TLS, or any evolving threat to the airway require inpatient management TUMORS OF THE THORAX Goals of Treatment The most critical decision making and care in the ED is the differentiation of emergent from nonemergent tumors of the thorax This difference is frequently driven by tumor location (see Fig 124.11 in Thoracic Emergencies chapter) CLINICAL PEARL AND PITFALLS Children with anterior mediastinal mass must be managed with the utmost caution Prevention of respiratory failure is critical, as these masses may be located below the carina, rendering even intubation ineffective Current Evidence Thoracic tumors can be caused by a number of childhood cancers While hematologic malignancies are common, embryonal neoplasms such as neuroblastoma, sarcomas such as primitive neuroectodermal tumor (PNET), and carcinomas can also present in the chest In general, there are no specific predisposing conditions or factors