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