1. 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.

2. Cross-sectional view slightly below level of aortic bifurcation

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

4.  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.

5.  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 65-66. Woodcock RJ, Gay SB. Radiology Recall. First Edition, Lippincott, Philadelphia, 2000, pg 633. ACR Code: 86.32 Shivam Champaneri, 2004