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A 23-year-old man was hospitalized because of hypertension, heart palpitations, headache, and sweating. Clinical investigation revealed a highly increased urinary excretion of norepinephrine. Radionuclide imaging with I-123 metaiodobenzylguanidine showed a series of hot spots at the lower portion of the left sympathetic chain. The radiotracer bears a structural resemblance to norepinephrine. It accumulates in neurosecretory storage granules of chromaffin cells and is used to localize of neural crest tumors. At surgery, four separate tumor masses were removed. The diagnosis was multifocal paragangliomas. One year after surgery, the patient is clinically well and the urinary catecholamines are normal.