Ganglioneuroma

Case contributed by Saeed Soltany Hosn
Diagnosis certain

Presentation

Acute onset lower back pain radiating into his right leg. On examination, the patient has scoliosis.

Patient Data

Age: 11 years
Gender: Male
x-ray
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AP and lateral view of the spinal column reveals scoliosis with a sharp angular bend associated with posterior scalloping of the vertebral bodies.

ultrasound
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Transverse US image shows a retroperitoneal lobulate border heterogenous echogenicity mass with average volume of 260 cc.

Bone Scan Tc-99m-MDP

Nuclear medicine
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On the dynamic phase,normal perfusion and blood pool activity was noted at the region of lumbar and thoracic spine. On the static phase,severe lumbar scoliosis with focal heterogeneous increased uptake of L1 to L3 as well as T4 were detected. Other parts of skeletal system revealed normal activity.There is retention of activity in the region of left kidney.

ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial renal
cortical phase
This study is a stack
Axial C+
delayed
Sagittal renal
parenchymal phase
Sagittal C+ portal
venous phase
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Fusiform longitudinal soft tissue density mass is present against T12 - L2 vertebrae associated with extension in to the spinal canal which causes canal widening and posterior scalloping of mentioned vertebrae. Scoliosis with convexity to the left side is noted. There are also infiltration of left iliopsoas muscle and anterior displacement of left kidney. In addition there are bilateral widening of neuoroforamina in T12-L2 vertebrae. 

Case Discussion

Findings are consistent with neurofibromatosis and sudden onset of patient's symptoms is suggestive of neurofibrosarcoma. Patient went on to have a biopsy, but histopathology confirmed ganglioneuroma.

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