Volume 24, Issue 103, May - June, 2020

Spontaneously ruptured pheochromocytoma with retroperitoneal hematoma mimicking acute myocardial infarction and acute pancreatitis

Elzaki M E Ahmed¹, Abdulaziz Nakhilan Alshammari², Badr Saad Alharbi¹, Mona Fraih Alshammari¹, Hamood Ali Alharbi¹, Odai Abdullah Abaalkhail¹, Jehad Hamad Alkhalaf¹, Roohi Khan², Imran khan², Hussain Gadelkarim Ahmed^3,4♦

¹King Fahd Specialist Hospital, Buraydah, Saudi Arabia
²King Khaled Hospital, Hail, Saudi Arabia
³College of Medicine, University of Hail, Saudi Arabia
⁴Department of Histopathology and Cytology, FMLS, University of Khartoum, Sudan

^♦Corresponding author
Prof. Hussain Gadelkarim Ahmed, College of Medicine, University of Hail, Saudi Arabia; Email: hussaingad5@gmail.com

ABSTRACT

Pheochromocytoma exhibits variable characteristics with diverse presentations; its diagnosis can be extremely challenging in emergencies. Pheochromocytoma rupture is an uncommon and extremely rare lethal clinical condition, making it even more essential to recognize early signs and characteristics. We report a case of spontaneously ruptured pheochromocytoma in a 35-yearold Pakistani male patient who initially presented with chest pain, dyspnea, and diaphoresis with increased blood pressure and an electrocardiogram showing ischemic changes mimicking acute myocardial infarction. Cardiac angiography, performed immediately, showed normal results. His chest pain subsided after treatment with painkillers and aspirin; his blood pressure was closely monitored and controlled. He developed sudden severe boring epigastric pain radiating to the back and between the shoulder blades, mimicking acute pancreatitis. An urgent abdominal CT scan was obtained, which revealed the pain source to be a ruptured adrenal mass on the left side leading to retroperitoneal hemorrhage. Follow-up blood test results showed increased leukocytes and a drop in the hemoglobin level compared with the initial level. The patient's fluctuating blood pressure was treated upon admission, and elective surgery was performed on day 7 of his stay. Lab. investigations showed increased catecholamine levels in his plasma and urine, whereas histopathology of the biopsied mass confirmed pheochromocytoma. The patient was discharged with a recommendation for regular follow-up after successful surgery with proper blood pressure control. Correct diagnosis and elective surgery after controlling blood pressure are the most important prognostic factors in managing such cases. We describe this case in terms of its treatment for ruptured pheochromocytoma through a literature review.

Keywords: Pheochromocytoma, rupture, retroperitoneal, hematoma, blood pressure, adrenal mass

Medical Science, 2020, 24(103), 1439-1444

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