Multimedia
 | Media file 1: Axial nonenhanced T1-weighted MRI shows a hypointense mass in the retroperitoneum originating from the left adrenal gland. The mass displaces the left kidney in an anterolateral direction, it extends through the neuroforamen into the spinal canal, and it displaces the spinal cord to the right. The exact site of origin of large masses can be difficult to determine. Sympathetic-chain primaries supposedly invade the spinal canal with greater frequency than do adrenal primaries. |
 | Media file 2: Axial T2-weighted MRI in the same patient as in Image 1 again demonstrates extradural extension into the spinal canal. The tumor appears hyperintense. Spinal cord displacement is better demonstrated on T2-weighted images than on other images. |
 | Media file 3: Sagittal T2-weighted MRI in the same patient as in Images 1-2 shows a hyperintense extradural mass in the lower thoracic spine.Axial and coronal images confirm that this is extradural extension of a neuroblastoma of the left adrenal gland. |
 | Media file 4: Coronal T2-weighted MRI in the same patient as in Images 1-3 shows a hyperintense mass in the left adrenal gland. The mass is extending cephalad into the spinal canal via the neuroforamen. |
 | Media file 5: Intravenous pyelogram (IVP) shows a classic drooping-lily sign involving the right kidney. This patient had a known right adrenal neuroblastoma. |
 | Media file 6: Another intravenous pyelogram (IVP) shows an inferiorly displaced kidney on the right. Above the right kidney are stippled calcifications. These findings are consistent with those of a neuroblastoma. |
 | Media file 7: This intravenous pyelogram (IVP) was obtained in a toddler who presented with abdominal pain and a palpable mass in the left flank. A drooping-lily sign is present on the left. The patient was referred for further workup. |
 | Media file 8: Transverse sonogram of the left renal area was obtained in a patient whose intravenous pyelogram (IVP) is shown in Image 7. Sonogram shows an inhomogeneously hyperechoic, extrarenal mass that laterally displaces the kidney (which appears as a relatively hypoechoic structure). |
 | Media file 9: Anteroposterior (AP) views of both knees show irregular lucencies in both distal femoral and proximal tibial metaphyses; these represent relatively symmetrical metastatic disease. |
 | Media file 10: Image shows a destructive metastatic lesion involving the proximal fibular metaphysis with periosteal reaction in the proximal fibular diaphysis. |
 | Media file 11: This patient has enhancing dural metastases near the frontal and occipital lobes. This finding could result in widening of the sagittal suture on plain images of the skull. |
 | Media file 12: Classic hair-on-end appearance of a destructive metastatic lesion of the skull. |
 | Media file 13: Frontal view of the chest shows a mass in the right thorax behind the heart. Posterior rib changes and the lateral view (Image 14) confirm that this is a posterior mediastinal mass. Note splaying and thinning of the ribs in the lower rib cage on the right. This was a thoracic neuroblastoma. |
 | Media file 14: Lateral view of the chest in the patient in Images 13-17 confirms the posterior mediastinal mass. |
 | Media file 15: Nonenhanced axial CT scan of the chest in a patient with a thoracic neuroblastoma (same patient as in Images 13-17) shows a large, right posterior mediastinal mass extending into the spinal canal and displacing the cord laterally to the left. |
 | Media file 16: Axial T2-weighted chest MRI in the same patient as in Image 15, who had a thoracic neuroblastoma, shows a large, right posterior mediastinal mass extending into the spinal canal and displacing the cord laterally to the left. The mass is hyperintense on T2-weighted images. |
 | Media file 17: Sagittal T2-weighted MRI of the chest in the same patient as in Image 16 shows a large, hyperintense, right posterior mediastinal mass extending into the spinal canal through multiple neuroforamina. |
 | Media file 18: Anteroposterior (AP) or preorbital view of the skull shows widening of the sagittal and lambdoid sutures. This finding is due to dural metastases. |
 | Media file 19: Lateral view of the skull shows widening of the coronal sutures and multiple lucencies in the parietal and frontal bones of the skull in this patient with metastatic neuroblastoma. |
 | Media file 20: Axial CT scan of the orbits shows a heterogeneous-appearing, metastatic soft-tissue mass in the right orbit that displaces the globe and lateral rectus muscle medially. This patient presented with proptosis of the right eye. |
 | Media file 21: Axial CT scan of the orbits in the patient in Image 20, obtained a few millimeters cephalic, shows calcifications in the left orbital mass. |
 | Media file 22: Bone window in a patient with bilateral proptosis shows osseous destruction involving both lateral orbital walls (left to right). |
 | Media file 23: Bone-window axial CT study of the orbits (same patient as in Image 22) shows extensive bony destruction involving both frontal bones. |
 | Media file 24: Coronal CT scan of the orbits and sinuses shows a large, enhancing, and expansile mass occupying the ethmoid air cells that is invading the cribriform plate and breaking through to the left anterior cranial fossa. This entity is known as an esthesioneuroblastoma. Image courtesy of Michael Lev, MD. |
 | Media file 25: Technetium-99m methylene diphosphate (MDP) bone scan shows a focus of intense activity in the left lower quadrant of the abdomen adjacent to the spine, above the bladder. This finding corresponds to a neuroblastoma in this location. Image shows activity in the dilated renal calyces on the left, which suggests partial obstruction of the left ureter by the mass. No evidence of metastatic disease is observed. |
More on Neuroblastoma |
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 Multimedia: Neuroblastoma |
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References
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Further Reading
Keywords
neuroblastoma, esthesioneuroblastoma, ganglioneuroblastoma, ganglioneuroma, neuroectodermal tumor, neuroblasts, Homer-Wright rosettes, pediatric neoplasm, pediatric malignancy, Hirschsprung disease, fetal alcohol syndrome, Digeorge syndrome
