Raccoon eyes and the MIBG super scan: scintigraphic signs of neuroblastoma in a case of suspected child abuse.

The authors report on an infant suspected of having been abused, who presented with periorbital edema and ecchymoses (clinical "raccoon eyes"). The pattern of the nuclear medicine bone scan suggested neuroblastoma rather than trauma. Both the bone scan and the subsequent MIBG scan revealed multiple abnormalities, including markedly increased activity around the orbits, that we termed the scintigraphic raccoon eyes sign. In addition, the grossly abnormal MIBG scan demonstrated avid uptake of MIBG throughout the entire skeleton with essentially complete absence of visualization of the liver and heart (the MIBG super scan ). These signs have not previously been described in an infant or a child with neuroblastoma.