An Unusual Location for a Lymph Node.

Area of Science:

• Cardiovascular Medicine
• Oncology
• Nephrology

Background:

• A 67-year-old female with a history of hypertension since age 24, complicated by chronic kidney disease and hypertensive heart disease, presented with an incidentally discovered lesion near the abdominal aorta on CT-Chest.
• The lesion, measuring 16x14x23mm, was initially suspected to be a paraganglioma, a diagnosis not fully excluded by subsequent MRI.
• Preoperative investigations included urine analysis revealing normal metanephrine and slightly elevated Chromogranin-A levels.

Observation:

• During a video-assisted thoracoscopic surgery (VATS) procedure, a bulging was noted beneath the adventitial layer of the descending aorta.
• Upon opening the adventitia, a lipomatous lesion with a nodular, consistent center was identified and subsequently excised.

Findings:

• Histopathological examination confirmed the lesion to be a lymph node, with no evidence of neoplasia or a neuroendocrine component.
• The excised lesion was identified as a benign lymph node, not a paraganglioma or other neoplastic entity.

Implications:

• Despite the absence of a neuroendocrine tumor, the patient experienced significant clinical improvement in arterial hypertension 12 months post-surgery.
• This case highlights the importance of thorough histopathological evaluation for incidentally discovered aortic lesions and suggests potential indirect mechanisms for hypertension improvement.
• The patient remains under surveillance in the Thoracosurgical Outpatient Clinic with a good clinical outcome.