A Not So Simple Retroperitoneal Mass-A Clue from Hypertensive Crisis

Parasa Mrunalini

doi:10.4172/2155-6148.1000347

Abstract

Extra adrenal paragangliomas are tumours of chromaffin cells arising from the sympathetic and parasympathetic divisions of the autonomic nervous system. About 75% of them are located between the origin of the inferior mesentric artery and bifurcation of the abdominal aorta known as the organ of Zuckerkandl.1Their clinical presentations are varied and are mostly due to the excessive secretion of catecholamines by the tumour. The incidence of the classic triad of Headache, Palpitations and Diaphoresis is seen in as little as 24% of cases. 2A recent review reports hypertension to be paroxysmal in 48%, persistent in 29% and absent in 13 % of cases. 2 About 49% of cases are incidentally diagnosed during abdominal imaging. 2 These tumours may be confused with other common retroperitoneal neoplasms, especially when the patient is asymptomatic. We report a severe hypertensive crisis in such an asymptomatic patient, which was triggered on induction of anesthesia and manipulation of the tumour and its successful management in a patient with undiagnosed paraganglioma.

Highlights

Extra adrenal paragangliomas are tumours of chromaffin cells arising from the sympathetic and parasympathetic divisions of the autonomic nervous system
We report a severe hypertensive crisis in such an asymptomatic patient, which was triggered on induction of anesthesia and manipulation of the tumour and its successful management in a patient with undiagnosed paraganglioma
There was no history of hypertension, headache, perspiration, syncope, pain abdomen or pregnancy induced hypertension. Her vital parameters were normal during pre-anesthetic assessment with a blood pressure of 110/80 mmHg, pulse rate of 90/ minute and all the preoperative blood investigations and ECG were within normal limits

Summary

Introduction

Extra adrenal paragangliomas are tumours of chromaffin cells arising from the sympathetic and parasympathetic divisions of the autonomic nervous system. The tumour was incidentally diagnosed two years ago during a routine antenatal scan and the patient was advised to return for follow-up after delivery. She subsequently underwent caesarean section uneventfully under spinal anesthesia. There was no history of hypertension, headache, perspiration, syncope, pain abdomen or pregnancy induced hypertension Her vital parameters were normal during pre-anesthetic assessment with a blood pressure of 110/80 mmHg, pulse rate of 90/ minute and all the preoperative blood investigations and ECG were within normal limits.

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