CT - CT Abdomen and pelvis
Axial C+ portal venous phase
Coronal C+ portal venous phase
Which parts of the clinical presentation favours neuroblastoma as a diagnosis?
Generalised abdominal pain and distension. Note : A palpable mass may also be a clinical feature of a Wilm's tumour.
Would the age of the patient be suggestive for a neuroblastoma or a Wilm's tumour?
Neuroblastoma commonly affects young infants less than 2 years of age with the mean aged incidence at 22 months.
There is a large heterogeneous mass occupying the left flank and upper quadrant. It measures 14 cm craniocaudally, 10 cm anteroposteriorly and 11.5 cm transversely. No obvious calcification in the lesion is identified. A claw sign is present with some normal appearing renal parenchyma in the left renal lower pole at the inferior edge of the lesion, suggestive of a mass arising from the left kidney. Extrinsic compression of the left renal vein but no thrombus within the left renal vein or within the inferior vena cava. No active bleeding within the tumour mass is seen. There is mild hydronephrosis of the lower pole of the left kidney.
There is soft tissue in the left para-aortic position, displacing and partially compressing the abdominal aorta, including some soft tissue at the anterior, posterior and left side of the abdominal aorta, with the lower half of the abdominal aorta being displaced to the right. The splenic vessels and pancreas are displaced anteriorly due to the left abdominal mass. No involvement of the spleen and no splenomegaly. No focal liver lesions. The gallbladder is normal in appearance. The right kidney is normal.
A small amount of free fluid is present in the pelvis, posterior left upper quadrant and posterior to the spleen. No free gas.