Ji Hye Kim MD, Abstract Co-Author: Nothing to Disclose

Kyung Mi Jang MD, Abstract Co-Author: Nothing to Disclose

So Young Yoo MD, Presenter: Nothing to Disclose

Gye Yeon Lim MD, Abstract Co-Author: Nothing to Disclose

Myung-Joon Kim MD, Abstract Co-Author: Nothing to Disclose

Ok Hwa Kim, Abstract Co-Author: Nothing to Disclose

To evaluate the radiological and clinical findings of the congenital cystic neuroblastoma in comparison with cystic presentation of the neonatal adrenal hemorrhage.

We analyzed US (n=29), CT (n=14), and MR (n=4) images and medical records of 16 neonates and young infants with adrenal cysts (9 pathologically proven neuroblastomas and 7 adrenal hemorrhage diagnosed by surgical resection (n=2) or follow-up changes). The location, size, presence of the wall enhancement, internal septations, solid portion, calcification, turbidity of the cysts, and follow-up changes on images were compared between two groups. In addition, history of the prenatal detection and level of the urinary catecholamine were identified from the medical records. Fisher's exact test was used to evaluate significant imaging findings in differentiation of the two groups of the adrenal cysts.

All cysts except 2 neuroblastomas were located on the right side. The size range of the cysts at diagnosis was 3-7.5 x 2.6-4.5cm (mean, 4 x 4cm) in neuroblastomas and 2.5-8.8 x 3-6.2cm (mean, 5 x 3cm) in hemorrhages. Enhancement of the cystic wall, internal septation, and solid portion were seen in 6 (67%), 7 (78%), 4 (57%) of the 9 neuroblastomas and 2 (40%, of 5 enhanced scans), 5 (71%), 5 (71%) of the 7 hemorrhages each. The cystic fluid was turbid in all but one neuroblastoma and tiny calcification was noted in 2 neuroblastomas. The adrenal hemorrhage disappeared (n=4) or evolved to calcifications only (n=1) on follow-up images. Two neuroblastomas became smaller complex masses after 2 and 6 months later each. The imaging findings were not significantly different (p>0.05) between two groups. Eight of the nine (89%) neuroblastomas and one (14%) hemorrhagic pseudocyst were detected prenatally and the level of urinary VMA was elevated in only one patient with a neuroblastoma.

Prenatally detected or left sided adrenal cyst is more likely to be a neuroblastoma rather than hemorrhage. Imaging findings are not helpful in differentiation of the two groups. Normal urinary catecholamine assay and decreased size on follow-up images cannot exclude possibility of the neuroblastoma.

Kim, J, Jang, K, Yoo, S, Lim, G, Kim, M, Kim, O, Postnatal Imaging Findings of the Congenital Cystic Neuroblastoma and Adrenal Hemorrhagic Pseudocyst.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419836.html