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Findings: Abdominal plain films. Nonspecific, nonobstructive gas pattern; no appendicolith. Soft tissue mass in midabdomen displacing transverse colon inferiorly and descending colon laterally. Loss of psoas sign.

CT: Large suprarenal mass; irregular marginal heterogeneous texture. Right kidney displaced laterally without distortion of collecting system. Compression but no frank encasement of IVC.

Differential Diagnosis: Once determined not to be of kidney or liver origin, differential diagnosis includes: neuroblastoma, gangiolneuroblastoma, ganglioneuroma. Less likely exophytic Wilm's tumor, adrenal carcinoma, pheochromocytoma.

Diagnosis: Neuroblastoma

Discussion: Neuroblastoma: Most common solid abdominal mass of infants. Third most common malignant tumor of infants (behind leukemia. CNS) Neural crest origin; 50% less than 2 years of age. 75% less than 4 years of age Common presentation. palpable abdominal mass, pain and fever, increased catecholamine production. Heterogeneous mass, stippled calcification, displaced more than distorted kidney.

Staging:

• I. Organ of origin (adrenal. postenor mediashnum most common)
• II. Regional spread - no crossing of midline
• III. Extension across midline
• IV. Distant mets (nodes, liver, bone, brain, lung)
• V. Stage I or II and disease Continued to liver. skin. bone marrow

References:
1. Blickman JG Pediatric Radiology- The Requisites. Mosby. St Louis. 1994.
2. Dahnert. Wolfgang Radiology Review Manual - Second Edition Williams and
Wilkins. Baltimore. 1993

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