Unsuspected pheochromocytoma incidentally found on chest CT

Abstract

A 51-year-old woman with history of migraine headaches and intermittent nausea, vomiting, palpitations, and diaphoresis presented to the emergency department with hypertensive emergency 1 month after starting a beta blocker for migraine prophylaxis. Contrast-enhanced computed tomography of the chest incidentally revealed a large abdominal mass in the area of the left adrenal gland. Iodine-123 metaiodobenzylguanidine scan imaging showed localized uptake into the left adrenal gland. Along with imaging results, laboratory testing confirmed the diagnosis of pheochromocytoma. The patient was treated with blood pressure control, specifically alpha blockade, and surgical excision of the mass. This case displays a typical clinical presentation of pheochromocytoma coupled with atypical radiographic size and appearance.

Ectopic pheochromocytoma or paraganglioma of the ZUCKERKANDL organ: A case report and review of the literature

“…Imaging helps localize the tumour and give its features. It holds an important place in the diagnosis of pheochromocytomas and paragagliomas [2,10,12,13]. In our case, CT scan was the diagnostic examination, but did not contribute to an accurate diagnosis of the organ.…”

Asymptomatic and Biochemically Silent Pheochromocytoma with Characteristic Findings on Imaging

“…123 I-MIBG scintigraphy may be useful for identification of tumors missed by MRI or CT. It can also be used for identifying catecholamine-secreting paragangliomas, multifocality, or multiple smaller masses throughout the body, such as metastasis [ 12 , 13 ].…”

Feocromocitoma Pheochromocytoma

“…La incidencia del PHE varía de 2 a 8 personas por cada millón en la población general (5) . No presenta diferencia entre ninguno de los sexos, en su mayoría se presentan entre la cuarta y quinta década.…”

“…La triada clásica de los feocromocitomas se presenta en un 20 a un 40% de los pacientes, y se compone de cefalea intermitente (80%), palpitaciones o taquicardia (64%) y diaforesis (57%) (2,3,5) . También se identifican flushing, tremor, palidez, ansiedad e hipotensión ortostática.…”

“…Una crisis aguda tiene repercusiones con alta morbi-mortalidad, entre las que destacan el infarto agudo al miocardio, el evento cerebrovascular y la muerte (5) . Se han descrito también casos de abdomen agudo secundario a una necrosis tumoral (3) .…”