Sympathetic ganglion tumours are rare neoplasms representing a biological continuum ranging from benign ganglioneuroma to malignant neuroblastoma, with ganglioneuroblastoma being an intermediate form. They originate from nerve cells rather than nerve sheaths and can occur in sympathetic ganglia and adrenal glands. Ganglioneuromas are benign neoplasms usually occurring in children and young adults. Ganglioneuroblastomas exhibit variable degrees of malignancy and usually occur in children. Neuroblastomas are highly malignant tumours that typically occur in children younger than 5 years of age. The posterior mediastinum is the most common extra-abdominal location of a neuroblastoma.

Ganglioneuromas and ganglioneuroblastomas usually arise from the sympathetic ganglia in the posterior mediastinum and therefore usually present radiologically as well-defined elliptical masses, with a vertical orientation, extending over the anterolateral aspect of  three  to five vertebral bodies. Calcification occurs in approximately 25%. CT appearance is variable. On MR, ganglioneuromas and ganglioneuroblastomas are usually of homogeneous intermediate signal intensity on T1- and T2-weighted images. Neuroblastomas are typically more heterogeneous, caused by areas of haemorrhage, necrosis, cystic degeneration and calcium. They may be locally invasive and have a tendency to cross the midline.

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