Challenging Case

Dr. Ali M AhmadMBBCh, MS, MD, MRCS-Ed, EBPS

Associate Consultant Pediatric Surgery; KAAUH_ PNU

• Previous healthy 2 y Female

• DOA : 18-1-2007

• Referred to KFMC from outside Riyadh

• One month history of SOB & Cough

Chest x-ray

Oxygen dependent 6 L /min

Hemorrhagic drain ~ 40 ml /day

Chest x-ray

CT chest, abdomen & pelvis

CT chest, abdomen & pelvis

CT chest, abdomen & pelvis

CT chest, abdomen & pelvis

• Huge soft tissue Homogeneously mass• Extending from the apex downward till the liver dome• Containing calcification• No definite extension to the neural foramen• ICT inserted to the right side of the thorax is noted

• After IV contrast the mass: o Heterogeneously enhancing with multiple hypodense areaso Mass effect displaced the mediastinal structure to the left sideo Collapsed right lung lobeo Liver, Pancreas, Spleen, left adrenal and both kidneys are

unremarkable

Findings

MIBG SCAN

Positive MIBG uptake

Right chest

and Bone Marrow

US guided Core Biopsy

Neuroblastoma

– Stage iv– bone & bone marrow metastasis

chemotherapy: Cisplatin Adramycin cyclophosphamide others

Before chemotherapy After chemotherapy

Challenging Case

Dr. Ali M AhmadMBBCh, MS, MD, MRCS-Ed, EBPS

Associate Consultant Pediatric Surgery; KAAUH_ PNU