Radiological Case of the Month: Neuroblastoma

Craig E. Barnes, MD; Ashley D. Hawkins, BA; Michael Y. Chen, MD

Disclosures

March 18, 2005

Abstract and Case Summary

A healthy 2-month-old white infant boy was found by his pediatrician to have a palpable pelvic mass at his well child check. The patient had no clinical symptoms at the time. Laboratory values were significant for an elevated urine homovanillic acid (HVA)/creatinine ratio of 361, and a normal urine vanillylmandelic acid (VMA)/creatinine ratio. Radiography (Figure 1), ultrasonography (Figure 2), computed tomography (CT) (Figure 3), and magnetic resonance (MR) imaging (Figure 4) were performed.

Supine abdominal radiograph shows a soft-tissue fullness or mass (M) in the right lower pelvis with displacement of the bowel related to mass effect. No calcification or osseous abnormality is seen.

Transverse ultrasonography of the upper pelvis shows a solid well-circumscribed, mildly heterogeneous mass with focal internal echogenicity, which is consistent with calcification (arrow).

This contrast-enhanced axial CT scan of the upper pelvis shows a solid well-circumscribed mass with mild enhancement and faint calcification (arrow) abutting the lower lumbar spine with anterior displacement of the bowel and bladder (B).

A sagittal short tau inversion recovery MR image of the pelvis before administration of contrast shows a well-circumscribed, elongated, heterogeneous, and mildly hyperintense presacral mass (M) with neuroforaminal tumor extension (arrow) along the lower sacrum. The bladder (arrowhead) has been displaced anteriorly.

A healthy 2-month-old white infant boy was found by his pediatrician to have a palpable pelvic mass at his well child check. The patient had no clinical symptoms at the time. Laboratory values were significant for an elevated urine homovanillic acid (HVA)/creatinine ratio of 361, and a normal urine vanillylmandelic acid (VMA)/creatinine ratio. Radiography (Figure 1), ultrasonography (Figure 2), computed tomography (CT) (Figure 3), and magnetic resonance (MR) imaging (Figure 4) were performed.

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