Background: A 15 month old female presented to Sydney Children’s hospital in May 2006 with stage IV neuroblastoma. At diagnosis she had a right adrenal primary with metastases to abdominal lymph nodes and bone. She was treated with surgical resection of the primary, chemotherapy, radiotherapy and autologous bone marrow transplantation in November 2006. She was well with no evidence of disease recurrence until early October 2007, when she developed chicken pox.

Image Findings: In late October 2007 an I123 MIBG scan revealed abnormal uptake in the mid zone of the right lung raising concern of recurrent neuroblastoma. On the basis of the scan findings a CT was performed and revealed consolidation in the anterior segment of the right upper lobe with air bronchograms. The patient was treated for infection with antibiotics and received no further therapy for neuroblastoma. A follow up MIBG scan performed 3.5 months later was normal and the CT scan at that time confirmed resolution of the previously demonstrated consolidation.

Conclusion: This case study demonstrates I123 MIBG uptake in pneumonia, a phenomenon which has not been previously described. The diagnosis of pneumonia rather than recurrent neuroblastoma was confirmed on clinical follow-up. The only treatment given was antibiotic therapy.