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Neuroblastoma presenting as hip pain and skull prominence in a child
Hunter R Hewitt1, Kimberly L Fugok1, Marna Rayl Greenberg1
1Departments of Emergency and Hospital Medicine, CC & I-78 2545 Schoenersville Rd, Muhlenberg Campus LVH, 5th floor EM Residency Suite, Allentown, PA 18103.
Insights
Neuroblastoma, a childhood cancer, can present with varied symptoms like hip pain and gait issues, complicating diagnosis. Early suspicion of malignancy is crucial for timely intervention in children with unusual symptoms.
Area of Science:
- Pediatric Oncology
- Medical Diagnostics
Background:
- Neuroblastoma is a prevalent pediatric malignancy, primarily affecting children under five.
- Diagnosis can be challenging due to diverse clinical presentations.
- Gait dysfunction is an uncommon presenting symptom for neuroblastoma.
Observation:
- A 6-year-old female presented with acute right hip pain and gait disturbance.
- She also developed a palpable lump on her right parietal skull.
- Initial presentation did not strongly suggest malignancy.
Findings:
- Magnetic Resonance Imaging (MRI) confirmed a left adrenal neuroblastoma.
- Metastatic disease was identified in the femur, lumbar spine, and skull.
- The disparate symptoms were indicative of widespread neuroblastoma.
Implications:
- Highlights the importance of considering malignancy in pediatric patients with atypical symptoms.
- Emphasizes the need for comprehensive diagnostic workups in cases of unexplained pain or neurological deficits.
- Underscores the potential for neuroblastoma to manifest with varied and seemingly unrelated clinical signs.
Abstract:
Neuroblastoma is a common cancer in children especially those under 5-years old, however they can have varied presentations that may make diagnosis difficult. Neuroblastoma is not usually high on a clinician's differential for a child's gait dysfunction. We describe a case of a 6-year-old female who presented to the Emergency Department for new onset right hip pain. She had associated gait disturbance and pain with ambulation as well as a new lump on her right parietal skull. An MRI of the brain, lumbar spine, and pelvis revealed the diagnosis of a left adrenal neuroblastoma that had metastasized to the femur, the lumbar spine, and the skull. This case shows the importance of early suspicion of malignancy in a patient with seemingly disparate symptoms to ensure early intervention.
