[size=6]A 3-year-old boy has a 6 cm left posterior chest mass at the costovertebral angle that extends from T8 to T12. In planning resection, it would be important to obtain a

 

a MRI of the spine

 

b Cardiac ultrasound

 

c CT angiogram

 

d Chest CT[/size]

A

A

[size=6]A 3-year-old boy has a 6 cm left posterior chest mass at the costovertebral angle that extends from T8 to T12. In planning resection, it would be important to obtain a

 

a MRI of the spine

 

b Cardiac ultrasound

 

c CT angiogram

 

d Chest CT[/size]

A

A

A

A

correct answer

c CT angiogram

 

About 90% of posterior mediastinal masses are neurogenic, with neuroblastoma being the most common tumor.

 

Injury to the artery of Adamkiewicz (AKA) during surgery may lead to spinal cord ischemia and severe neurologic complications. In about 90% of patients, the artery of Adamkiewicz (AKA) is located between levels T8 and L1, and nearly 80% of AKAs arise from the left side. The artery takes a characteristic "hairpin turn" at its anastomosis with the anterior spinal artery, and supplies the spinal cord with arterial blood. Disruption (dissection of an aortic aneurysm, spinal surgery) can lead to cord ischemia and paralysis. It is named after Albert Wojciech Adamkiewicz (1850-1921), a Polish physician and neuropathologist.

 

Since this location is at risk for possible injury to the AKA during surgery, infiltration of the costovertebral junction between vertebral levels T9 and T12 is defined as an image-defined risk factor (IDRF) in the International Neuroblastoma Risk Group Staging System (INRGSS).

 

Therefore, preoperative identification of the artery of Adamkiewicz by CT angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography is advised in cases with this IDRF