The differential diagnosis for adrenal gland calcification in children includes calcified adrenal hemorrhage, tuberculosis and histoplasmosis, and tumors, most commonly neuroblastoma and ganglioneuroma. Wolman’s disease is a reare genetic disorder of lipid metabolism associated with enlarged calcified adrenal glands and hepatosplenomegaly. Neuroblastoma is the most common abdominal malignancy in the newborn, but a rare disease with an incidence of 1:30,000. Most patients are less than two years of age; those diagnosed at less than one year of age have a better overall prognosis.

Neuroblastomas arise from cells of neural crest origin and can originate anywhere from cervical region to pelvis. Approximately two-thirds arise in the abdomen and two-thirds of these arise in the adrenal glands. 65% of patients present with metastatic disease, most often to bones, bone marrow, liver, lymph nodes and skin. 85-95% of neuroblastomas contain calcification , often visible on plain radiographs. Neuroblastomas readily extend across midline, with a characteristic tendency for vessel encasement.