A 4-Year-Old boy presented with intermittent postprandial nausea and vomiting for 6 weeks resulting in a 2.72-kg loss of weight. There was no history of trauma or previous abdominal surgery and general medical history was noncontributory. Results of a clinical examination revealed an apyretic comfortable child with a nontender mass palpated on the left side of the midabdomen. The abdomen was otherwise soft with normal bowel sounds and no guarding or rebound tenderness.
Laboratory study results revealed a normal leukocyte count, slightly elevated serum urea nitrogen level of 9.5 mmol/L, normal epinephrine level (normal, 300-600 pg), and elevated norepinephrine level of 3.58 nmol/L (normal, 0-0.59 nmol/L).
A chest radiograph was unremarkable. Abdominal ultrasonogram revealed an unremarkable left kidney and left adrenal gland without any evidence of an abdominal mass.
A computed tomographic scan (Figure 1) of the abdomen using oral barium contrast medium and an upper gastrointestinal tract series (Figure
Hill JG, Yaakob W, Hebra A. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1997;151(9):943-945. doi:10.1001/archpedi.1997.02170460081014