title: Neuroblastoma presenting as persistent postprandial emesis in a neonate.
abstract: Early identification and treatment of neuroblastoma, the most common malignant solid tumor in infants, (Atkinson et al. AJR Am J Roentgenol. 1986;146:113-117; Nuchtern. Semin Pediatr Surg. 2006;15:10-16; Lanzkowsky. Manual of Pediatric Hematology and Oncology. 4th ed. Burlington, MA: Elsevier Academic Press; 2005:530-547) can improve prognosis of this illness. Benign emesis as an initial presentation of infantile neuroblastoma is rare (Isaacs. Fetal Pediatr Pathol. 2007;26:177-184). We report a case of a 17-day-old healthy male who presented to the emergency department with persistent, nonprojectile emesis after feedings. A diagnosis of nonresectable stage IV thoracoabdominal neuroblastoma with invasion to the spine was made. We concluded that oncological processes, such as neuroblastoma, should be included in the differential diagnosis of persistent emesis in the neonatal period. Emergency physicians may have the opportunity to detect neuroblastoma earlier by contemplating a broader differential diagnosis of a vomiting infant and initiating the appropriate workup in the emergency department.
authors.affiliation: From the *Department of Emergency Medicine, University of California Irvine Medical Center, Orange; and †Department of Emergency Medicine, Long Beach Memorial Medical Center and Miller Children's Hospital, Long Beach, CA.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Rezaimehr
authors.forename: Rishi
authors.initials: R
authors.lastname: Bhargava
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000652:urine; D002454:Cell Differentiation; D003907:Dexamethasone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004630:Emergencies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D019518:Postprandial Period; D013117:Spinal Cord Compression / Q000209:etiology; D013904:Thoracic Vertebrae; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology*
chemical_list: D014408:Biomarkers, Tumor; D003907:Dexamethasone