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

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. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h