Neuroblastoma. Diffuse infiltration of liver

    Child 2 months old in intensive care unit with a diagnosis of a right adrenal gland tumor (neuroblastoma).

    Appointed US due to the progressive enlargement of the abdomen (fluid?).

    Consulted by surgeon, it suggested that it' s a swollen bowel loops.

    Visually abdomen sharply enlarged.

    At US almost all the abdominal cavity filled by the liver which is visualized even in the pelvis, right lobe antero-posterior size in the right upper quadrant (!) 8cm, length about 15 cm (probe in the pelvis).

    In the projection of the lower pole of the right kidney visualized echogenic lesion (with slightly higher echogenicity than hepatic), with anechoic inclusions, size of 4x3 cm, with blood flow at CFM; left kidney is normal.

    In the lower left quadrant of the abdomen / pelvis visualized (subhepatic) bowel loops and a small amount of free fluid.

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    To the question of normal adrenal gland imaging, as it's often done in some medical centers, measured the soft tissue above the upper pole of the kidney and everyone is happy.

    In this case, the adrenal lesion is localized in the projection of the lower renal pole because adrenal gland, in practice, are not always localized in the projection of the upper pole of kidney, and usually not visualized on ultrasound.

    While taking into account the localization in this case could be suspected nephroblastoma (Wilms' tumor) but as I spoke before the case was verified.

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    "Wilms Tumor Imaging

    ...

    Abdominal neuroblastomas usually develop in the retroperitoneum. Most arise from the adrenal gland and displace the kidney inferomedially. In rare cases, a neuroblastoma may mimic a Wilms tumor, arising from tissues in the kidney or invading the kidney. To make diagnosis complicated, rare neuroblastomas possess other features more typical of Wilms tumor than of intrarenal neuroblastomas."

    As in the present case, the tumor site is not a typical arrangement of the adrenal gland, kidney does not displaced inferomedially but vice versa ...