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Findings: MRI Findings: Large paraspinal mass with hyperintense heterogeneous signal growing through and widening the neural foramen in the epidural space causing displacement of the cord to the left.
CT Findings: Large thoracic mass with punctate calcification posteriorly.
Diagnosis: Neuroblastoma.
Discussion: Paraspinal masses which can occur in children to consider include neuroblastoma, schwannoma, neurofibroma, or drop metastasis from medulloblastoma, ependymoma, glioma or pineal gland tumor. Drop metastasis most often appears as nodular areas along the cord. Schwannomas and neurofibromas often have similar MR appearance being iso or slightly hyperintense on T1 to muscle and hyperintense on T2. However, only neuroblastoma is likely to have calcifications. Neuroblastoma is the 3rd most common malignancy of childhood behind leukemia and primary brain tumor. Approximately 75% of patients are less than four years old at the time of diagnosis. Neuroblastoma often arise from the adrenal medulla but can also form anywhere along the sympathetic ganglion. Pathologically, the neuroblastoma is in the spectrum with ganglioneuroma, a benign tumor, and ganglioneuroblastoma which is of intermediate malignant potential. At diagnosis, 70% of patients have disseminated disease. Metastasis most often involves bone, liver and skin.
References:
Kirks D. Practical Pediatric Imaging, 2nd Ed. 1991.
Barkovich A. Pediatric Neuroimaging, 1990.
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