Occult neuroblastoma presenting with opsomyoclonus: utility of computed tomography

The clinical and radiographic findings in 10 children with neuroblastoma presenting with opsomyoclonus are described and the literature is reviewed. Children with opsomyoclonus are often a diagnostic dilemma, as they may not have a palpable tumor or increased urinary catecholamines. Computed tomography (CT) is the most sensitive imaging method in locating tumors (100%) compared with plain radiography of the chest and abdomen (sensitivity 40%), excretory urography (50%), and 99mTc radionuclide bone scans (50%). The use of body CT significantly shortened the interval between initial presentation and final diagnosis and avoided multiple hospitalizations and unnecessary investigations for patients with persistent opsomyoclonus. Since most neuroblastomas are solitary lesions that may arise in the adrenal glands or along the sympathetic chain from the neck down into the pelvis, our policy is to use plain radiography, sonography, and 99mTc methylene diphosphonate (MDP) bone scans for the preliminary investigation of patients with opsomyoclonus. Body CT can then be tailored to suit the needs of the individual patients.