Neuroblastoma is a primitive ganglion tumor that can arise in the adrenal, other abdominal location, chest, or neck. Patients can present with a painless mass, hepatomegaly, or symptoms of mass effect from compression of the bowel, bladder, lymphatics, spinal cord, trachea, or superior vena cava. Occasionally, retrobulbar metastasis can cause raccoon eyes and proptosis. Paraneoplastic manifestations can include hypertension, watery diarrhea, and opsoclonus-myoclonus syndrome (rapid, multidirectional eye movements and jerking of the extremities). CBC for evidence of bone marrow infiltration and chest radiograph for mediastinal mass should be obtained in the ED.