Case contributed by Rad_doc


1 month of poor appetite and lethargy. Mom recently noticed a distended belly.

Patient Data

Age: 16 months
Gender: Male

Large soft tissue density in the left upper quadrant displacing bowel inferiorly. No calcifications are identified. 

Your physical exam confirms the presence of an abdominal mass. 

Abdominal Ultrasound


Large heterogeneous, solid intra-abdominal mass. It appears to arise from the left retroperitoneum and causes substantial mass effect on the left kidney without appearing to arise from the left renal parenchyma.

CT Abdomen

  1. Large heterogenously enhancing mass compressing the left kidney.
  2. Cavernous transformation of the portal vein likely secondary to obstruction by mass.
  3. Ascites.
Annotated image

You will find several annotated studies demonstrating the mass in a fuschia outline. 

Patient went to the operating room and pathologic specimen confirms the diagnosis of Neuroblastoma. 

Case Discussion

Neuroblastomas are the most common extracranial solid childhood malignancies and the third commonest childhood tumors after leukemia and brain malignancies. The tumors typically occur in infants and very young children (mean age of presentation being ~22 months) with 95% of cases diagnosed before the age of 10 years.

Clinical presentation

Typically with pain or a palpable mass and abdominal distension, although numerous other presentations may be encountered due to local mass effect.


Neuroblastomas arise from the sympathetic nervous system:

Intra-abdominal disease (two-thirds of cases) is more prevalent than the intrathoracic disease. Specific sites include:

  • adrenal glands: most common site of origin, 35%
  • retroperitoneum: 30-35%
  • posterior mediastinum: 20%
  • neck: 1-5%
  • pelvis: 2-3%

See: Neuroblastoma article for more details.

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