CASE PRESENTATION  History: This patient is an almost three-year-old girl who presented with a two week history of ataxia and opsomyoclonus (loss of coordination and rapid-random eye movements)  Physical exam: Normal. No palpable masses or lymphadenopathy was appreciated.  Labs: All labs (including CBC & Chem panel) were within normal limits, except for a low MCV  Imaging: Head CT was done initially, but was normal. CT of chest, abdomen, and pelvis (with contrast) was then ordered.

Cross-sectional view slightly below level of aortic bifurcation

Cross-sectional view two levels below previous image showing a 2.9 x 3.4 x 3.1 cm mass with calcifications

 Differential Dx: For a mass in the para-aortic region with calcification, must consider neuroblastoma (66% have calcification) or a retroperitoneal teratoma. Can consider aortic aneuryism, but this mass did not enhance with contrast.  Hospital course: Patient underwent surgical removal of the mass as well as some pelvic, para- iliac, para-caval, and peri-aortic lymph nodes without any complications.  Pathology: Mass was a neuroblastoma with unfavorable histology and one positive lymph node in the para-iliac region. All other nodes were negative.  Other studies: Bone scan and bone marrow biopsy to evaluate for other mets were negative.

 Treatment: Given that this is at least a stage 2 tumor with unfavorable histology, treatment involves surgical removal and chemotherapy. Patient was started on the standard regimen of cisplatin, etoposide, doxorubicin, and cyclophosphamide. References: Webb WR, Brant WE, Helms C. Fundamentals of Body CT. Second Edition, W.B. Saunders, Philadelphia, 1998, pg Woodcock RJ, Gay SB. Radiology Recall. First Edition, Lippincott, Philadelphia, 2000, pg 633. ACR Code: Shivam Champaneri, 2004