Stage IV neuroblastoma.
A. Anterior (A) and posterior (P) bone scintigraphy images of a 16-month-old child show multiple foci of abnormal uptake, including the right facial bones, left acetabulum, and left femur (arrows). Faint uptake is present in the primary left adrenal tumor (arrow on posterior image). B. 123I MIBG scintigraphy also demonstrates uptake in the primary tumor (arrow), mediastinal metastatic lymphadenopathy, and multiple sites of skeletal metastasis (arrows). C. A contrast-enhanced CT image shows the primary tumor in the left suprarenal region. There is encasement of the aorta and superior mesenteric artery.