An adrenal or paraspinal mass with calcification that encases vessels and may enter the spinal canal; staging uses image-defined risk factors (IDRFs) — encasement, invasion, intraspinal extension — and MIBG shows the metastases.
Orient first
- Commonest extracranial solid tumour of infancy; calcification in most.
- INRGSS stages L1 (no IDRFs), L2 (IDRFs present), M (metastatic), MS (young infants with skin, liver, marrow disease) — verify.
- Metastases: bone (periorbital "raccoon eyes"), marrow, liver.
Acquire the study
- Portal venous phase CT; thin reformats.
The manoeuvre
- Mass with calcification (most) in the adrenal or paraspinal region; size in cm in three planes.
- IDRFs on axial and coronal reformats: encasement of the aorta, coeliac, SMA, renal vessels; lifting of the aorta.
- Intraspinal extension through the neural foramina (dumbbell).
- Liver metastases on the portal venous phase; bone metastases on bone window.
What confirms it
- Histology or marrow with raised urinary catecholamines; stage by INRGSS.
What licenses you to exclude it
- A renal-origin mass displacing vessels favours Wilms.
The classic misread
- Missing intraspinal extension — MRI is better.