Korean J Radiol.  2011 Feb;12(1):52-58. 10.3348/kjr.2011.12.1.52.

Comparison of Clinico-Radiological Features between Congenital Cystic Neuroblastoma and Neonatal Adrenal Hemorrhagic Pseudocyst

Affiliations
  • 1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea. jhkate@skku.edu
  • 2Department of Radiology, St. Mary's Hospital Catholic University, Seoul 150-713, Korea.
  • 3Department of Radiology, Severance Hospital Yonsei University, Seoul 120-752, Korea.
  • 4Department of Radiology, Ajou University Hospital, Gyeonggi-do 443-721, Korea.

Abstract


OBJECTIVE
To evaluate the radiological and clinical findings of congenital cystic neuroblastomas as compared with those of the cystic presentation of neonatal adrenal hemorrhage.
MATERIALS AND METHODS
We analyzed the US (n = 52), CT (n = 24), and MR (n = 4) images as well as the medical records of 28 patients harboring congenital cystic neuroblastomas (n = 16) and neonatal adrenal hemorrhagic pseudocysts (n = 14). The history of prenatal detection, location, size, presence of outer wall enhancement, internal septations, solid portion, calcification, turbidity, vascular flow on a Doppler examination, and evolution patterns were compared in two groups of cystic lesions, by Fischer's exact test.
RESULTS
All (100%) neuroblastomas and three (21%) of the 14 hemorrhagic pseudocysts were detected prenatally. Both groups of cystic lesions occurred more frequently on the right side; 11 of 16 (69%) for neuroblastomas and 11 of 14 (79%) for hemorrhagic pseudocysts. The size, presence of solid portion, septum, enhancement, and turbidity did not differ significantly (p > 0.05) between the two groups of cystic lesions. However, tiny calcifications (n = 3) and vascular flow on color Doppler US (n = 3) were noted in only neuroblastomas. The cystic neuroblastomas became complex solid and cystic masses, and did not disappear for up to 90 days in the three following cases, whereas 11 of the 14 (79%) hemorrhagic pseudocysts disappeared completely and the three remaining (27%) evolved to calcifications only.
CONCLUSION
Although the imaging findings of two groups of cystic lesions were similar, prenatal detection, the presence of calcification on initial images, vascularity on color Doppler US, and evolution to a more complex mass may all favor neuroblastomas.

Keyword

Neonate; Adrenal hemorrhage; Neuroblastoma

MeSH Terms

Adrenal Gland Diseases/*diagnosis
Adrenal Gland Neoplasms/*congenital/*diagnosis
Catha
Cysts/*diagnosis
Diagnosis, Differential
Female
Hemorrhage/*diagnosis
Humans
Infant
Infant, Newborn
Male
Neuroblastoma/*congenital/*diagnosis
Tomography, X-Ray Computed
Ultrasonography

Figure

  • Fig. 1 Congenital cystic neuroblastoma in 61-day-old girl. A. US shows internal turbidity and tiny calcifications (arrow) in internal septum. B. Color Doppler US demonstrates septal vascularity (arrow). C. Contrast-enhanced CT scan shows enhancement of internal septum and outer wall of cyst (arrows).

  • Fig. 2 Evolution of adrenal hemorrhage in 11-day-old boy. A. Initial US demonstrates turbid and septated cystic mass. B. Cystic mass (white arrows) decreased in size, retaining its cystic appearance on follow-up US obtained two months after. C. After four months, no demonstrable residual lesion was observable.

  • Fig. 3 Cystic neuroblastoma in 8-day-old girl. A. US shows pure cystic mass in right suprarenal area. B. T2-weighted MR images reveal fluid-fluid level exhibiting dark signal intensity, suggesting hemorrhage (arrows). C. Outer wall (shown by arrows) is enhanced on contrast-enhanced T1 weighted image.

  • Fig. 4 Adrenal hemorrhagic cyst in 42-day-old girl. A. US shows suprarenal, turbid cyst containing diffuse low-level echoes. B, C. T1-(B) and T2 (C)-weighted MR images show T1, T2 shortening of dependent level of fluid (arrows) and outer wall (white arrows), suggesting hemorrhage. D. Contrast-enhanced T1-weighted image demonstrates outer wall enhancement (arrows).

  • Fig. 5 Evolution of cystic neuroblastoma in 63-day-old boy. A. Initial US shows left adrenal cystic mass (arrows) with internal septation (white arrow). B, C. Cyst (white arrows) became smaller and more complex solid cystic masses on US (B) and T2-weighted MR (C) images obtained after one and two months, respectively. Dark signal intensity rim may suggest previous hemorrhage (arrows).


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