Long-segment narrowing of the abdominal aorta and its branches in a survivor of infantile neuroblastoma treated without radiation therapy.

Narrowing of the abdominal aorta and renal arteries (mid-aortic syndrome) after treatment for neuroblastoma has been attributed to radiation therapy. We present a child with neuroblastoma, successfully treated without radiation therapy, who developed mid-aortic syndrome and hypertension. MR imaging demonstrated encasement of the aorta at presentation. Following successful treatment, long-segment aortic narrowing and narrowing of the proximal renal arteries were present. Hypertension has improved during a 5-year period although renal artery stenosis persists. The incidence of mid-aortic syndrome in children with neuroblastoma is unknown. Etiologies include vascular injury from radiation or chemotherapy, the effect of catecholamines secreted by the tumor on arterial growth, arterial injury at the time of surgery or a constitutional predisposition to the development of both neuroblastoma and mid-aortic syndrome.