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Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a 4 year old male who presented to an outside institution with increased perspiration.
Clinical Physical Exam:
Clinical Differential Diagnosis:
A computed tomography exam of the abdomen demonstrated a large right adrenal mass.
Images 1, 2, and 3
Imaging Differential Diagnosis:
Neuroblastoma vs. pheochromocytoma
The patient was taken to the operating room at the outside institution for an exploratory laparotomy. The surgeon immobilized the right adrenal mass and found evidence of intracaval extension of tumor. The outside surgeon was unable to secure a cardiopulmonary bypass team willing to back him up for taking the tumor out of the inferior vena cava and he therefore terminated his laparotomy and sent the child to our institution for definitive surgery.
Several days later the patient underwent re-exploration by reopening his transverse right abdominal wound. A 6 cm right adrenal mass that was quite adherent to the inferior vena cava was found. There was tumor extension of about the size of a marble into the cava through the adrenal vein. A right adrenalectomy with removal of the intracaval extension of tumor was performed.
Examination of the surgical specimen revealed characteristic findings of pheochromocytoma.
Pheochromocytoma (Right Adrenal)
Follow-up and Prognosis:
The patient had a history of familial pheochromocytoma, with his father and sister having undergone bilateral adrenalectomies for pheochromocytoma. The patient had an uncomplicated post-operative course.
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