A 69-year-old white man presented to the emergency department after a tractor-on-tree collision. Contrast-enhanced computed tomography demonstrated an incidental right infrarenal, retroperitoneal mass measuring 9.7 × 7.7 × 9.1 cm (Figure 1A), with dilated tortuous supply from a lumbar artery branch and retroperitoneal lymphadenopathy. He denied any history of systemic symptoms, pain, urinary symptoms, or abnormal bowel function but described 6 years of decreased appetite. Laboratory evaluation of plasma-free metanephrine levels showed a slight elevation in normetanephrine levels (1.21 nmol/L). Given the dramatic arterial enhancement and hypertrophied perivascular plexus, biopsy was not performed, and preoperative arterial embolization was deemed appropriate to minimize intraoperative blood loss.
Costacurta PW, Shaver AC, Idrees K. An Incidental Hypervascular Retroperitoneal Mass. JAMA Surg. 2017;152(9):887–888. doi:10.1001/jamasurg.2017.2147
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