Incidental Neuroblastoma
A 5-month-old boy with a 2-month history of coughing was taken to the pulmonology clinic. No other associated symptoms were present. Vital signs and physical examination were normal. An anteroposterior chest radiograph showed a fusiform mass in the left paraspinal region that formed an obtuse angle with the spine (Panel A, asterisk). A subsequent computed tomographic image of the chest showed a posterior mediastinal mass (Panel B); radiologic features of the mass (not seen in this image) included calcifications, heterogeneous enhancement, and extension into the intervertebral foramina. Histopathological examination of a surgical biopsy specimen revealed neuroblastoma. Neuroblastoma is a tumor derived from neural crest cells that arises in tissues of the sympathetic nervous system. When the tumor originates from the paravertebral sympathetic ganglia in the chest, it may be detected incidentally on a chest radiograph. In this case, compression of the lung tissue by the mass was thought to be the cause of the patient’s cough. Owing to the patient’s young age at diagnosis, genetic testing for familial neuroblastoma was performed and was negative. The patient underwent partial surgical resection of the tumor, and chemotherapy was administered. At a 1-year follow-up visit, the patient was well and had no tumor recurrence.