PMC4901157_01
9-day-old infant with thoracic neuroblastoma. AP (A) and Lateral (B) chest radiographs demonstrating a large chest mass. Note the widening of the posterior rib interspace (green arrow), localizing the mass to the posterior mediastinum. On the lateral view, the blue asterisk denotes the mass, displacing the heart anteriorly.
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A chest radiograph was performed at an outside hospital, and it was mistakenly believed to show cardiomegaly and a large thymus (Figs. 1A and 1B).
9-day-old infant with thoracic neuroblastoma. Axial contrast-enhanced CT scan through the mid-chest. A heterogeneously enhancing mass occupies the left posterior mediastinum (blue asterisk) with speckled calcifications (red arrowheads), neural foramen invasion (green arrow), and ipsilateral rib destruction. Note the anterior and righward deviation of the mediastinal structures.
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On the day the patient was referred to us, a chest CT revealed the mediastinal mass (Fig. 2).
9-day-old infant with thoracic neuroblastoma. Axial T2 (A) and sagittal T1 postcontrast (B) images of the mass demonstrate an enhancing, T2 bright lesion in the left posterior mediastinum (blue asterisk) with some calcifications (red arrowhead), and neural foramen invasion (green arrow).
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T2 through T8 levels (Figs. 3A and 3B). The patient was immediately taken to the OR for thoracotomy with biopsy of the chest mass as well as bilateral posterior iliac crest bone marrow aspirates and biopsies.
9-day-old infant with thoracic neuroblastoma. I-123 MIBG nuclear medicine scan. Note abnormal uptake in the left chest (green arrow) and normal uptake in the liver (red arrowhead).
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An I-123 MIBG scan, performed ten days after the surgery, showed intense uptake of I-123 MIBG at the site of the mediastinal mass (Fig. 4).