Ruptured Pheochromocytoma Presenting with Acute Abdomen and Pulmonary Edema

Abstract

F i g u r e 1 A. Ch e s t r a d i o g r a p h t a k e n a t t h e t i me o f a d mi ss i o n s h o we d d i f f u s e g r o u n d -g l a s s o p a c i t y o n b o t h l u n g s .F i g u r e 1 B . No n c o n t r a s t -e n h a n c e d CT s c a n s h o we d a r i g h t a d r e n a l ma s s wi t h r e t r o p e r i t o n e a l h e ma t o ma . * , r i g h t a d r en a l ma s s ; a r r o wh e a d s , r e t r o p e r i t o n e a l h e ma t o ma . (Fig. 1A). Abdominal computed tomography (CT) showed a hyper-enhancing right adrenal mass with retroperitoneal hematoma (Fig. 1B = non contrastenhanced CT, Fig. 1C, D= serial images of an arterial phase contrast-enhanced CT). The serum and urine catecholamine levels were markedly elevated. showed uptake at the right supra-renal region (Fig. 1E). Based on these findings, the diagnosis of ruptured right adrenal pheochromocytoma was made. Volume supplementation and intravenous/intraoral administration of α-adrenergic blocking agents were continued. The pulmonary edema and dyspnea resolved rapidly without using cardiotonic or diuretic drugs. The patient subsequently underwent surgery. *

A case of ruptured pheochromocytoma causing loss of life of a patient due to delay in diagnosis

“…In the literature, it has been found that emergency surgery without suitable BP checks and an incorrect preoperative diagnosis are strongly associated with a worse prognosis [3]. The death rate for the 54 cases in the literature was 34% [1,7]. Because the diagnosis was not made preoperatively, we could not give the patient α-adrenergic blockage therapy, instead, the patient was only given crystalloid fluid and erythrocyte suspension.…”

A rare cause of acute abdomen: Ruptured adrenal pheochromocytoma

“…The mortality rate was 31% for the 54 cases reported in the literature (9,10). The most important factor affecting the results of the surgery is the resuscitative treatment, which is done at the time of diagnosis and perioperatively (9).…”

Spontaneous rupture of pheochromocytoma: computed tomography–pathologic features and correlation

“…Although the mechanism of tumor rupture is unclear, TANAKA et al reported that rapid tumor growth or hemorrhage can increase the intratumoral pressure, which can subsequently cause not only tumor necrosis but also tumor rupture (2). There are several case reports showing a few CT or magnetic resonance imaging (MRI) figures, but none has described the imaging features in detail (2)(3)(4)(5). Moreover, most of these reports did not correlate the imaging and pathology features.…”

“…An adrenal hemorrhage is frequently associated with predisposing factors including trauma, sepsis, and coagulopathy (6)(7)(8). For these reasons, a spontaneous adrenal hemorrhage is extremely unusual and is sometimes observed in cases with a ruptured pheochromocytoma (1)(2)(3)(4)(5). A ruptured pheochromocytoma has frequently been reported to be a cyst-like tumor on CT or MRI, probably resulting from extensive cystic or necrotic changes (2,4,5).…”