Nephroblastoma vs. Neuroblastoma, Adrenal Gland
Left picture: The diagnosis is a nephroblastoma of the left kidney and not a splenomegaly. Considering the age of the girl, the knowledge of the disease entity, and a careful and gentle palpation a correct clinical diagnosis would have been possible. Right picture: The diagnosis in this case is a neuroblastoma of the left adrenal gland which displaces the left kidney to the bottom but otherwise does not alter the structure of the pelvicocaliceal system. This is a radiological sign to differentiate it from a nephroblastoma.
Left picture: The 4.5-year-old boy was admitted with the diagnosis ´splenomegaly´ for work-ups. The IVU shows an increased left kidney with a mass in the intermediate part and in the lower pole. In contrast to the part of pelvicocaliceal system which is recognizable as part of the upper pole, the residual kidney displays a structural alteration. In the ultrasound an inhomogeneous mass is visible instead of the kidney, which cannot not be associated with a kidney; for that see the figure at the bottom of the same patient. Right picture: Retrograde pyelography of the left side in a girl just beyond infancy with a palpable left abdominal tumor. The pelvicocaliceal system is well recognizable, and the number of calices is not diminished. Nevertheless, the picture reminds of a withered flower. Left picture: In the IVU only the calices of the upper pole have a normal structure.