Case Report
Lumbar plexus schwannoma causing recurrent syncope

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Abstract

Retroperitoneal schwannomas are rare and present non-specifically. They usually manifest secondary to their compressive effects on adjacent structures. We describe a patient who presented with recurrent syncope resulting from a large retroperitoneal schwannoma stretching the inferior vena cava and compromising venous return. We also discuss the salient aspects of preoperative investigations leading to definitive diagnosis and surgery.

Introduction

Schwannomas are a rare group of soft tissue neoplasms arising from peripheral nerve sheaths. Retroperitoneal schwannomas account for only 0.5% to 3% of all tumours in this region.1 Their clinical presentation is usually non-specific or incidental.2 To our knowledge we describe the first reported patient with a retroperitoneal schwannoma presenting with recurrent syncope and discuss aspects of the clinical, radiological and histopathological features in managing this condition.

Section snippets

Case report

A 54-year-old female patient was referred with a palpable right lower abdominal mass and several weeks of recurrent syncope. Her syncope occurred while bending over, or leaning forwards, in a sitting position against a table. On examination, her blood pressure (BP) decreased from lying (130/70 mmHg) to standing (100/50 mmHg), and dizziness was elicited on deep palpation of her abdominal mass. No lymphadenopathy, café au-lait spots or other stigmata of neurofibromatosis was noted. There was also

Discussion

Since the retroperitoneum is lax, benign schwannomas frequently reach a large size before diagnosis. Clinical features are likely secondary to mass effect and are therefore dependent on the exact location of the tumour. The most common symptoms are abdominal pain, bloating and constipation.1 Less commonly, renal colic, haematuria, urinary incontinence, ureteric obstruction and secondary hypertension have been reported due to compression along the urogenital tract.[1], [3], [4] A case of

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