Ganglioneuromas (GN) are rare, mature tumors that arise in the posterior mediastinum or retroperitoneum from neural crest cells and present as slow growing masses in the pediatric population. While they are often found incidentally in unrelated diagnostic workup, they can become symptomatic due to their size and location. They typically demonstrate the nonspecific appearance of a solid mass without invasive or destructive features across different modalities. Such features are normally indicative of more aggressive neoplasms from similar cellular ancestry or an entirely different lineage. Here we present a case of mediastinal GN that on imaging was initially suggestive of an osteochondroma with malignant degeneration based on the presence of an exostosis associated with a large solid mass. Final pathology, however, revealed GN with involvement of the adjacent bone. While the final diagnosis was benign, it is important to recognize this pattern of exostosis with solid mass, especially since the overall survival rate of sarcomata is much worse than that of a classic GN.
The investigation of embedded soft tissue foreign bodies relies heavily on radiological imaging. The prompt identification of these objects is critical as retained foreign bodies may lead to serious infection or chronic debilitating pain depending on anatomical location. In this report, we present a case of a radiographically occult traumatically implanted foreign body in a 15-year-old female after a high-speed motor vehicle accident. Initial computed tomography (CT) scan was unremarkable and exploration under anesthesia demonstrated no other significant findings, yet the patient continued to suffer severe refractory radicular pain with marked limitation of daily function. It was not until 12 weeks after the accident that a magnetic resonance image (MRI) of the pelvis revealed a deep sinus tract with central low magnetic resonance (MR) signal, raising suspicion for a retained foreign body. A 10-centimeter plastic foreign body extending from the patient's coccyx to the sciatic foramen was identified and surgically removed resulting in immediate symptom relief. This case illustrates that the detection of a retained foreign body is not always straightforward and multiple imaging modalities may be necessary for accurate diagnosis. We also discuss the most appropriate diagnostic imaging algorithm when a foreign body of the musculoskeletal system is suspected.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.