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This scan detected an incidental left adrenal mass. Diagnostic work-up including biopsy confirmed the adrenal mass as an intermediate risk left adrenal neuroblastoma with encasement of the left renal vessels and superior mesenteric artery.<\/jats:p>\n               <jats:p>To our knowledge, this is the first case of an infant patient with the VACTERL association and simultaneous diagnosis of a neuroblastoma. This case demonstrates how careful expert review of specialist imaging can incidentally reveal unexpected findings which require a significant alteration of a patient\u2019s treatment pathway.<\/jats:p>","DOI":"10.1136\/bcr-2025-265123","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T16:31:43Z","timestamp":1744129903000},"page":"e265123","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Expect the unexpected: neuroblastoma in a patient with the VACTERL association"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1908-2435","authenticated-orcid":false,"given":"Sarah","family":"Braungart","sequence":"first","affiliation":[{"name":"Paediatric Surgery, Royal Hospital for Children Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Daff","sequence":"additional","affiliation":[{"name":"Paediatric Surgery, Royal Hospital for Children Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"2025082712352345000_18.4.e265123.1","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.jpedsurg.2023.01.051","article-title":"Screening for VACTERL Anomalies in Children with Anorectal Malformations: Outcomes of a Standardized Approach","volume":"58","author":"Evans-Barns","year":"2023","journal-title":"J Pediatr Surg"},{"key":"2025082712352345000_18.4.e265123.2","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.10371"},{"key":"2025082712352345000_18.4.e265123.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmg.2007.04.002"},{"key":"2025082712352345000_18.4.e265123.4","doi-asserted-by":"crossref","DOI":"10.1186\/1750-1172-2-33","article-title":"Anorectal malformations","volume":"2","author":"Levitt","year":"2007","journal-title":"Orphanet J Rare Dis"},{"key":"2025082712352345000_18.4.e265123.5","doi-asserted-by":"crossref","unstructured":"Charles AK . 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