(CS36) The Old And Enigmatic

Introduction:

Neuroblastoma most commonly present with an abdominal mass. However, affected children may have various clinical presentation as a result of metastatic disease or associated paraneoplastic syndromes at the time of diagnosis.

Case Report/Description:

We report 3 cases with uncommon initial presentation of neuroblastoma.

First case is an 8-month-old girl who was initially admitted for bronchiolitis but incidentally noted to have “raccoon eyes” and anaemia. Further clinical examination revealed hepatomegaly. USG and CT studies showed a large right suprarenal mass with extensive liver, nodal, and bone metastases.

The second patient is a 2-year-old boy who presented with 7-months history of chronic diarrhea with persistent electrolyte imbalance. USG Abdomen was ordered to look for bowel pathology, and incidentally revealed a right suprarenal mass with calcification and vessel encasement consistent with neuroblastoma.

Another case is a 5-year-old girl with severe right hip pain and high-grade fever. Patient was extensively investigated for fracture/ septic arthritis. An MRI 2 months later noted an incidental left suprarenal mass with presence of liver, pelvis and bilateral femur bony metastases.

Discussion/Conclusion:

Awareness of the less common manifestations of neuroblastoma is crucial for both clinicians and radiologists in order to achieve a timely diagnosis hence expedite the management for patients.