Ventricular Thrombosis in Sippleʼs Syndrome

Pishdad, Gholam Reza

doi:10.1097/00007611-200011000-00010

Cited by 13 publications

(16 citation statements)

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“…3,4 To our knowledge, only 3 cases of LV thrombus associated with a pheochromocytoma have been reported in the English literature. [5][6][7] One case describes an 18-year-old woman with multiple endocrine neoplasia type 2 who had both medullary thyroid carcinoma and pheochromocytoma. 5 Her LV thrombus was incidentally identified and she exhibited normal LV function and wall motion.…”

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Thrombus and Embolic Stroke Caused by a Functional Paraganglioma

Buchbinder

Yu²,

Rosenbloom³

et al. 2009

J of Clinical Hypertension

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Pheochromocytoma and functional paraganglioma are uncommon causes of secondary hypertension. In rare instances, these catecholamine-secreting tumors present as atypical and dramatic symptoms without clear history of hypertension. We describe here LV thrombus and embolic stroke caused by a functional paraganglioma. CASE HISTORYA 49-year-old Caucasian man was admitted for elective transesophageal echocardiography to examine whether he had a patent foramen ovale. One month before this admission, the patient had flulike symptoms, left upper quadrant abdominal pain, and constipation for 2 weeks. He then developed a 1-minute episode of garbled speech and left upper extremity weakness that lasted for 24 hours. He was admitted into another hospital. An abdominal computed tomography (CT) scan revealed a large left retroperitoneal mass and multiple left renal infarcts. A head CT suggested stroke. Since the renal and brain infarcts suggested an embolic etiology, transthoracic echocardiography was performed, which detected a 1.3Â1.9 cm mobile mass in the mid left ventricle apparently attached to the interventricular septum (Figure 1, Left). Also noted was reduction of left apical wall motion. Transesophageal echocardiography was performed at the other hospital without complications and confirmed the transthoracic findings. On electrocardiography (ECG), the patient exhibited a prolonged QT interval and diffuse T-wave abnormalities especially on the precordial leads without evidence of atrial fibrillation (Figure 1, Right). Troponin levels were mildly elevated to 0.07 ng ⁄ mL (normal <0.05 ng ⁄ mL). Coronary angiography revealed normal coronary arteries. He was anticoagulated with heparin, then warfarin and enoxaparin, and was treated with metoprolol due to the abnormal ECG findings. On repeat echocardiography and cardiac magnetic resonance imaging (MRI) 2 to 3 weeks later, the left ventricular (LV) mass was not seen, but LV systolic function was still abnormal, with an ejection fraction of 47%. The distal left ventricle and apex thickened during diastole but moved dyskinetically during early systole.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7] One case describes an 18-year-old woman with multiple endocrine neoplasia type 2 who had both medullary thyroid carcinoma and pheochromocytoma. 5 Her LV thrombus was incidentally identified and she exhibited normal LV function and wall motion. The other 2 cases and our case share common features, which are summarized in the Table.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombus and Embolic Stroke Caused by a Functional Paraganglioma

Buchbinder

Yu²,

Rosenbloom³

et al. 2009

J of Clinical Hypertension

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“…Tal exceso, además de hipertensión arterial, náuseas, sudación y palpitaciones, puede acompañarse de diferentes manifestaciones cardiovasculares, como arritmias, eventos coronarios agudos y afección miocárdica orgánica o funcional, todo ello incluso sin enfermedad coronaria. Aunque en la bibliografía se encuentran descripciones puntuales de isquemia miocárdica aguda en el seno del cuadro clínico del feocromocitoma, son excepcionales los casos en los que la afección miocárdica se acompaña de trombosis intraventricular 1 . Comunicamos el caso de un paciente con un feocromocitoma adrenal con clínica de crisis catecolamínica, isquemia miocárdica difusa en el electrocardiograma (ECG), signos ecográficos de disfunción ventricular izquierda con acinesia apical y un trombo intraventricular izquierdo desarrollado precozmente.…”

Section: Introductionunclassified

Isquemia miocárdica aguda y trombosis ventricular asociadas a feocromocitoma

Yebra

Asenjo

Arrue

et al. 2005

Revista Española de Cardiología

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“…A review of the cases highlighted offers possible alternative explanations for thrombotic phenomena -including direct tumour invasion into the inferior vena cava, arising from a right adrenal tumour [12][13]15,19,22 ; venous stasis due to extrinsic tumour compression 14 ; a prothrombotic state further contributed by malignancy 21,29 or polycythaemia (arising in one case from tumour secretion of erythropoietin 21 ); and catecholamine-induced cardiomyopathy with intracardiac thrombus and thromboembolism [28][29][30]32,34,[36][37] . Nonetheless, there are cases of thrombosis for which these "alternative" mechanisms fail to account -for example, intracardiac thrombi without evidence of cardiomyopathy 31,33,35 . This corroborates the likely independent effect of catecholamine excess on systemic hypercoagulability.…”

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confidence: 99%

“…While no strong recommendation for prophylactic anticoagulation in phaeochromocytoma can yet be made, increased vigilance for arterial and venous thromboembolism in these patients could allow for earlier intervention and the avoidance of morbidity. Table 1 Case Report Age Gender Tumour location / largest diameter Arterial thromboembolism / venous Dural 12 17 M Right adrenal, 10cm IVC, right atrium Hartgrink 13 38 F Right adrenal, 16cm IVC, right atrium Left latero-basal pulmonary embolism Kota 14 48 M Right adrenal, 7.6cm IVC up to confluence of hepatic veins Ku 15 21 F Right adrenal, 12cm IVC, right atrium Lucon 16 43 M Right adrenal, 6.5cm IVC Lucon 17 46 21 31 M Multiple abdominal phaeochromocytomas IVC, right common femoral vein, right inferior epigastric veins Waidelich 22 78 F Right adrenal, 8cm IVC, right adrenal vein Osman 23 U M Adrenal, details unknown Adrenal +/-renal vein Stella 24 38 M Right adrenal, 4-5cm Cerebral venous sinuses Brauchlin 25 51 M Ectopic (pelvis), recurrent, 8cm Portal vein Robert 26 43 M Ectopic (organ of Zuckerkandl), 7cm Superior mesenteric vein 29 13 M Left adrenal, 8.5cm LV thrombus Right middle cerebral artery Bilateral acute lower limb ischaemia Heindel 30 49 M Left adrenal, 10cm 3 LV thrombi (0.5-1.0cm) Right cerebellar and cortical infarcts; right frontal lobe infarct Right foot ischaemia Hou 31 47 F Left adrenal, 8cm "Large" LV thrombus Left axillary artery Mrdovic 32 53 F Left adrenal, size unknown "Large" LV apical thrombus Pishdad 33 18 F Right adrenal, 8cm LV thrombus (2cm) Shafiq 34 47 M Mediastinal paraganglioma, 5.3cm 2 LV thrombi (1.43-1.8cm) Multiterritory (anterior / posterior circulation) cerebral infarcts Wiyono 35 43 M Left adrenal, size unknown "Large" LV thrombus Yebra Yebra 36 59 M Left adrenal, 3.5cm LV thrombus, 3x0.6cm Left-sided cerebral infarct Zhou 37 43 F Right adrenal, 7cm LV thrombi (28x17mm, 0.8x0.7mm) Multiple renal infarcts Bilateral femoral arteries; peroneal, anterior / posterior tibial arteries Kaiser 38 50 F Left adrenal, 7.8cm Right middle cerebral artery Right distal subclavian to radial artery Thewjitcharoen 39 47 F Right adrenal, size unknown Right renal artery Battimelli…”

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confidence: 99%

Case report: adrenal phaeochromocytoma presenting with ileus, renal vein thrombosis and pulmonary embolism

Lai¹,

Lee²,

Liew³

et al. 2015

EJEA

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A 56 year old man, previously well, presented to our Emergency Department with a 5-day history of abdominal distension, vomiting, breathlessness, and haemoptysis. He had a preceding history of hypertension, which had been diagnosed one year ago, and for which he was not on treatment. The gastrointestinal effects of phaeochromocytoma may range from mild and non-specific abdominal pain and vomiting 1 to more severe refractory constipation, ileus, and enterocolitis 3-8. Catecholamines suppress intestinal motility via direct effects on alpha-and beta-adrenergic receptors in the gut, resulting in reduced intestinal tone and peristalsis, and contraction of intestinal sphincters 4,6. Furthermore, catecholamine-mediated contraction of smooth muscle in the mesenteric vasculature, in combination with increased intestinal metabolic demand, result in bowel ischaemia, which in itself may contribute to dysmotility 4,6-8. Cases of paralytic ileus associated with phaeochromocytoma have been occasionally reported since the mid-1900s 3-8 , with ileus usually resolving after tumour resection and/or alpha-blockade 3-4,8. The recognition of ileus as a complication of phaeochromocytoma is important, as there is a possibility of progression to bowel infarction and perforation if diagnosis and treatment are delayed 4,6-7. Paralytic ileus and venous thromboembolism are two relatively uncommon manifestations of phaeochromocytoma. It is rarer still for both to occur simultaneously, as in our patient.

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Ventricular Thrombosis in Sippleʼs Syndrome

Cited by 13 publications

References 0 publications

Left Ventricular Thrombus and Embolic Stroke Caused by a Functional Paraganglioma

Left Ventricular Thrombus and Embolic Stroke Caused by a Functional Paraganglioma

Isquemia miocárdica aguda y trombosis ventricular asociadas a feocromocitoma

Case report: adrenal phaeochromocytoma presenting with ileus, renal vein thrombosis and pulmonary embolism

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