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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 34

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 34

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Four year old male with increased perspiration.

Clinical History:
The patient was a 4 year old male who presented to an outside institution with increased perspiration.

Clinical Physical Exam:

Clinical Labs:

Clinical Differential Diagnosis:
Pheochromocytoma, neuroblastoma

Imaging Findings:
A computed tomography exam of the abdomen demonstrated a large right adrenal mass.

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Imaging Differential Diagnosis:
Neuroblastoma vs. pheochromocytoma

Operative Findings:
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.

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Pathological Findings:
Examination of the surgical specimen revealed characteristic findings of pheochromocytoma.

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Final Diagnosis:
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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