Diagnostic features of tumors of the lower thoracic sympathetic chain

Four cases of sympathetic neural tumors of the most inferior portion of the thoracic sympathetic chain are presented. The location of each tumor was such that a primary adrenal tumor might have been considered. However, each tumor was associated with erosion of the ipsilateral lower ribs or vertebral pedicles. Such radiologic findings indicate a primary posterior mediastinal tumor and primary exploration should be transthoracic.