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JAMA Surgery Clinical Challenge
September 2017

An Incidental Hypervascular Retroperitoneal Mass

Author Affiliations
  • 1Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 3Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA Surg. 2017;152(9):887-888. doi:10.1001/jamasurg.2017.2147

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.

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