Presentation
Previously healthy boy presenting with a limp. He denied pain. No history of trauma.
Patient Data
AP View of Pelvis with both hips and lateral view of left hip demonstrates:
- mild diffuse ill defined sclerosis in the proximal left femoral metaphysis
- no discrete periostitis or osteolysis
- both hip joints are symmetric and congruent
- no evidence of hip joint effusion. No abnormal calcification
- normal bone density
Coronal images of CT Abdomen and Pelvis demonstrate;
- partially calcified left adrenal mass and densely calcified left paraspinal and retroperitoneal lymphadenopathy
- no discrete focal lesion in the liver and right adrenal gland
- ill-defined sclerosis seen on XR pelvis in the proximal left femoral metaphysis is not evident on these CT images on soft tissue windows
Case Discussion
The differential in the case was confirmed through appropriate imaging, and the patient was diagnosed with neuroblastoma on the initial visit with CT. Although neuroblastoma can often present with a wide range of symptoms including an abdominal mass, constipation, periorbital ecchymoses ("raccoon eyes"), paraspinal masses, back pain, opsoclonus-myoclonus syndrome, this patient presented only with a limp. The child was within the typical age range for neuroblastoma, which is commonly diagnosed between the ages of 1 and 5 years old.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center