Friday Quiz # 16 Answer | Figure 1

Cincinnati Children's Radiology

Axial contrast-enhanced CT of the abdomen (image 1) shows the large retroperitoneal mass (arrow) uplifting the abdominal aorta (arrowhead). There are diffuse bone metastases with an abnormal appearance of the vertebral bodies on the sagittal CT of the spine (image 2). MIBG scan (image 3) shows bone metastases involving the calvarium, humeri, ribs, spine, pelvis, and femurs. The imaging findings are consistent with neuroblastoma. Neuroblastoma most commonly arises from the adrenal glands. It displaces and uplifts vessels. Neuroblastoma most commonly metastasizes to bone, bone marrow, and the liver.

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Coronal and axial contrast enhanced CT

Coronal (image 1) and axial (image 2) contrast enhanced CT obtained in a child with neuroblastoma shows a large left neuroblastoma (arrowhead). The tumor crosses midline, partially encases the aorta, and extends into the inferior vena cava (arrow). There is also diffuse involvement of the pancreas (dashed arrow). Vascular invasion in patients with neuroblastoma is incredibly uncommon.

AP and lateral radiograph

AP (image 1) and lateral (image 2) radiograph of the distal femur shows an aggressive bone tumor with periosteal new bone formation (arrows), a Codman triangle (arrow on lateral view), and a permeative appearance of the bone. This patient was later diagnosed with neuroblastoma as seen on the MIBG scan (image 3).

MIBG scan

Anterior projection from an MIBG scan shows diffuse skeletal metastases and a large intra-abdominal neuroblastoma. The bone metastases are most pronounced in the skull. Neuroblastoma is the most common extracranial solid malignancy of childhood.

Sagittal and axial T1-weighted MR images

Sagittal (image 1) and axial (image 2) T1-weighted postcontrast MR images obtained in an adolescent with metastatic Ewing sarcoma show a skull metastasis affecting both the inner and outer table of the skull. When metastases occur, they most commonly affect the lungs and bones.