Extralobar pulmonary sequestration (EPS) and cystic neuroblastoma (CN) are rare pediatric thoracoabdominal masses with distinct yet sometimes overlapping imaging features, posing diagnostic challenges for radiologists. Accurate differentiation is crucial for guiding clinical management and preventing unnecessary interventions. This review focuses on comparing the imaging characteristics of EPS and CN, with emphasis on key features that aid in distinguishing between these entities. EPS typically presents as a well-defined, homogenous mass located near the lower lobes of the lung, often with systemic arterial supply visualized on contrast-enhanced imaging. It may exhibit smooth margins and is commonly identified in neonates and infants. Conversely, cystic neuroblastoma, while rarer, typically manifests as a retroperitoneal mass, often arising from the adrenal gland, with a more complex appearance, including cystic and solid components. Calcifications, which are frequently seen in neuroblastoma, may provide a critical clue for diagnosis, while the absence of systemic arterial supply differentiates it from EPS. Pitfalls arise from the potential overlap in appearance, such as fluid-filled or cystic components within both lesions, which may lead to confusion. Additionally, both lesions may be incidentally discovered on prenatal or early postnatal imaging, necessitating careful evaluation of ancillary features such as vascular supply, location, and internal characteristics to ensure accurate diagnosis. This review offers radiology residents, fellows, and attending radiologists a comprehensive comparison of EPS and CN imaging findings, with a focus on avoiding common diagnostic traps. Understanding these key differences enhances diagnostic confidence, promotes appropriate management, and improves outcomes for pediatric patients. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Mannuru Sravani, Hui Jessica, Lai Lillian

Keywords: Pediatric Radiology, Abdominal Imaging, Chest

Pediatric adrenal masses are rare but significant findings in clinical radiology, requiring careful evaluation due to their varied etiologies ranging from benign lesions to malignant tumors. For radiology residents, fellows, and attending radiologists, a systematic approach is essential for accurate diagnosis and management. This review highlights key imaging pearls and common pitfalls associated with pediatric adrenal lesions. The "pearls" include recognizing age-specific differentials, the importance of correlating clinical and biochemical findings, and the utility of advanced imaging techniques such as MRI for tissue characterization. Neuroblastoma, the most common malignant pediatric adrenal tumor, should be distinguished from benign entities like adrenal hemorrhage or hyperplasia based on imaging characteristics such as calcification, organ displacement, and vascular encasement. In contrast, pitfalls often arise from misinterpreting normal anatomic variations or failing to account for the dynamic nature of some lesions, such as hemorrhage or pheochromocytoma, which may change in size or appearance over time. Furthermore, the overlap in imaging features between benign and malignant lesions can lead to diagnostic uncertainty. This review emphasizes the need for a multidisciplinary approach, incorporating clinical, laboratory, and imaging data to avoid misdiagnosis and unnecessary interventions. Understanding the pearls and pitfalls of pediatric adrenal mass imaging will aid radiologists in providing more accurate and timely diagnoses, ultimately improving patient outcomes. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Mannuru Sravani, Hui Jessica, Lai Lillian

Keywords: Abdominal Imaging, Adrenal, Pediatric Imaging