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Najjar R, Paver E, McGuane J, Frahm‐Jensen G. Dissecting a diagnostic enigma: Hypertension in a young patient from an organ of Zuckerkandl paraganglioma. Clin Case Rep 2023; 11:e8061. [PMID: 37854255 PMCID: PMC10580690 DOI: 10.1002/ccr3.8061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Hypertension in young patients can mask rare conditions like paragangliomas, especially in the absence of conventional symptoms. A comprehensive diagnostic evaluation and multidisciplinary approach are crucial for optimal management and outcomes.
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Affiliation(s)
- Reabal Najjar
- The Australian National University Medical School, College of Health and Medicine, Australian Capital TerritoryCanberraAustralian Capital TerritoryAustralia
- The Canberra Hospital, Canberra Health ServicesCanberraAustralian Capital TerritoryAustralia
| | - Elizabeth Paver
- The Australian National University Medical School, College of Health and Medicine, Australian Capital TerritoryCanberraAustralian Capital TerritoryAustralia
- ACT Pathology, The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Jonathan McGuane
- The Australian National University Medical School, College of Health and Medicine, Australian Capital TerritoryCanberraAustralian Capital TerritoryAustralia
- ACT Pathology, The Canberra HospitalCanberraAustralian Capital TerritoryAustralia
| | - Gert Frahm‐Jensen
- Department of Vascular SurgeryThe Canberra HospitalCanberraAustralian Capital TerritoryAustralia
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Teter K, Jacobowitz G, Rockman C, Gupta M, Muntyan I, Pachter L. Surgical management of recurrent and extra-adrenal pheochromocytomas requiring vascular resection and reconstruction. J Vasc Surg Cases Innov Tech 2023; 9:101202. [PMID: 37799829 PMCID: PMC10547824 DOI: 10.1016/j.jvscit.2023.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 10/07/2023] Open
Abstract
This case series highlights that extra-adrenal and recurrent pheochromocytomas can require en bloc vascular resection to achieve negative margins. Through this series of cases performed in a multidisciplinary fashion, we aim to highlight the technical aspects of these cases that can add to their complexity. Vascular invasion alone should not preclude an otherwise feasible oncologic resection.
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Affiliation(s)
- Katherine Teter
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Mohit Gupta
- Department of Urology, NYU Langone Health, New York, NY
| | - Igor Muntyan
- Department of Anesthesia, NYU Langone Health, New York, NY
| | - Leon Pachter
- Division of General Surgery, Department of Surgery, NYU Langone Health, New York, NY
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Xue X, Wang D, Xiao Y, Ji Z, Xie Y. Functional paraganglioma with tumor thrombus in the inferior vena cava, first case report. Transl Androl Urol 2021; 10:1813-1820. [PMID: 33968670 PMCID: PMC8100850 DOI: 10.21037/tau-21-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and 131I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.
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Affiliation(s)
- Xiaoqiang Xue
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang J, Yuan D, Lu Y, Ma Y, Huang B, Yang Y, Zhao J. A large pheochromocytoma requiring aortic and inferior vena caval reconstruction: A case report. Medicine (Baltimore) 2019; 98:e16494. [PMID: 31335714 PMCID: PMC6709035 DOI: 10.1097/md.0000000000016494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE It is difficult to discriminate malignant pheochromocytoma (PCC) from benign PCC. The requirement of abdominal aortic and inferior vena cava reconstruction is extremely rare. PATIENT CONCERNS We here report a case of a large pheochromocytoma in a 56-year-old woman who complained of only hand trembling and had no hypertension or other symptoms. The operation was difficult because of a tight adhesion to the circumference of great vessels. A replacement of the aortocaval vessels with grafts was necessary to remove the tumor completely. DIAGNOSES Ultrasonography, computed tomography (CT), and catecholamine assay revealed suspecting the retroperitoneal PCC. INTERVENTIONS Tumor excision and reconstruction of the abdominal aorta and inferior vena cava by externally supported polytetrafluoroethylene (ePTFE) vessels were successfully performed. OUTCOMES A follow-up CT angiography showed no recurrence and graft vessels presented good patency after 7years. Catecholamine in urine and serum assay was normal. LESSONS The complete resection of the tumor and infiltrated great vessels were necessary for the long-term survival of patients with a large PCC. The ePTFE graft is a good substitute for vessel reconstruction.
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Affiliation(s)
- Jian Wang
- Department of Vascular Surgery, The West China Medical School of Sichuan University, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Ya Lu
- Department of Pathology, The West China Medical School of Sichuan University, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province
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Marker-Negative Pheochromocytoma Associated with Inferior Vena Cava Thrombosis. Case Rep Urol 2017; 2017:6270436. [PMID: 28702269 PMCID: PMC5494063 DOI: 10.1155/2017/6270436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/28/2017] [Accepted: 05/23/2017] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass.
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Salgaonkar H, Behera RR, Sharma PC, Chadha M, Katara AN, Bhandarkar DS. Laparoscopic resection of a large paraganglioma arising in the organ of Zuckerkandl: Report of a case and review of the literature. J Minim Access Surg 2016; 12:378-81. [PMID: 27251804 PMCID: PMC5022524 DOI: 10.4103/0972-9941.169990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paragangliomas are catecholamine-secreting neuroendocrine tumours arising from chromaffin tissue at extra-adrenal sites. The commonest site for a paraganglioma is the organ of Zuckerkandl. Traditional treatment of paraganglioma of organ of Zuckerkandl (POZ) involves open surgical resection, and only a few cases of laparoscopic approach to this pathology have been reported. We report the successful laparoscopic resection of a large POZ in a 22-year-old woman and review the previous cases reporting a laparoscopic approach to this rare tumour.
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Affiliation(s)
| | - Ramya Ranjan Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Manoj Chadha
- Department of Endocrinology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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Sadamori H, Monden K, Hioki M, Yoshimoto M, Ueki T, Hyodo T, Omonishi K, Kioka Y, Kuriyama M, Ohno S, Sakaguchi K, Matsuda T, Takakura N. Extra-Adrenal Retroperitoneal Paraganglioma with Extensive Duodenal Invasion and Inferior Vena Cava Tumor Thrombus. J Gastrointest Surg 2016; 20:1532-4. [PMID: 26921027 DOI: 10.1007/s11605-016-3109-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 01/31/2023]
Abstract
We report a case of extra-adrenal retroperitoneal paraganglioma (RP) with extensive duodenal invasion and tumor thromboses both in the right testicular vein and in the inferior vena cava (IVC). Because there was rigid adherence between the RP and the abdominal aorta, pancreatoduodenectomy with replacement of the IVC and aorta was performed for complete surgical resection. In the present case, both the mode of progression of the RP and the surgical approach were extremely rare.
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Affiliation(s)
- Hiroshi Sadamori
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan.
| | - Kazuteru Monden
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Masayoshi Hioki
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Masashi Yoshimoto
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Tsuyoshi Hyodo
- Department of Radiology, Fukuyama City Hospital, Fukuyama, Japan
| | | | - Yukio Kioka
- Department of Cardiovascular Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Mitsuhito Kuriyama
- Department of Cardiovascular Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Satoshi Ohno
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Kohsaku Sakaguchi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | | | - Norihisa Takakura
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
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Luethy D, Habecker P, Murphy B, Nolen-Walston R. Clinical and Pathological Features of Pheochromocytoma in the Horse: A Multi-Center Retrospective Study of 37 Cases (2007-2014). J Vet Intern Med 2015; 30:309-13. [PMID: 26613683 PMCID: PMC4913635 DOI: 10.1111/jvim.13799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/06/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022] Open
Abstract
Background Pheochromocytoma is the most common adrenal medullary neoplasm of domestic animals, but it is rare in horses. Antemortem diagnosis in horses is difficult, with clinical signs often being vague or non‐specific. Objective The objective of this study was to describe the clinical, laboratory, and pathologic findings of pheochromocytoma in horses. Animals Thirty‐seven horses diagnosed with pheochromocytoma based on postmortem examination from 2007 to 2014. Methods Retrospective case series. Results Pheochromocytoma was identified in 37/4094 horses during postmortem examination. Clinical signs consistent with pheochromocytoma had been observed antemortem in only 7 cases, with the remainder being incidental findings. Colic was the most common presenting complaint (13 of 37 cases) and tachycardia was noted in 95% of cases (median heart rate of 86 bpm in clinical cases). Hyperlactatemia (median, 4.9 mmol/L) and hyperglycemia (median, 184 mg/dL) were the most common clinicopathologic abnormalities. Hemoperitoneum caused by rupture of pheochromocytoma was noted in 4/7 clinical cases. Concurrent endocrine abnormalities (eg, thyroid adenoma, adrenal hyperplasia, pituitary pars intermedia hyperplasia or adenoma, parathyroid C‐cell carcinoma) were found in 27/37 horses, with 8/37 horses having lesions consistent with multiple endocrine neoplasia syndrome as described in humans. Conclusions Pheochromocytoma was diagnosed in 0.95% of horses presented for necropsy. The majority of these were incidental findings, but pheochromocytoma was thought to contribute to clinical findings in 19% of cases, and multiple endocrine neoplasms were commonly seen. Usually an incidental finding at necropsy, pheochromocytoma may cause acute death from intraperitoneal exsanguination and should be considered in horses presenting with colic, tachycardia, and hemoperitoneum.
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Affiliation(s)
- D Luethy
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, PA
| | - P Habecker
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, PA
| | - B Murphy
- School of Veterinary Medicine, Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA
| | - R Nolen-Walston
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, PA
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Kassahun WT. Update on the optimal management of patients with vascular extension of pheochromocytoma. Vascular 2014; 23:297-304. [PMID: 25034038 DOI: 10.1177/1708538114543845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Vascular extension of pheochromocytoma is extremely rare but highly resectable. The aim of this study was to review the available information in the literature for patients with this condition. METHODS A systematic literature search produced individual data for 29 treated patients with vascular extension of pheochromocytoma mainly to the inferior vena cava. RESULTS Out of 29 reported cases, 26 have been treated surgically. Nine of these patients required cardiopulmonary bypass. Two patients died untreated and one patient declined surgical treatment and discharged to follow-up. In 24 patients including nine with primarily missed diagnosis, surgery was documented as curative. CONCLUSION Surgeons need to be aware of this extremely rare characteristic feature of pheochromocytoma and indicated medical work-up in order to properly diagnose and manage this challenging group of patients.
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Kota SK, Kota SK, Meher LK, Jammula S, Panda S, Modi KD. Coexistence of pheochromocytoma with uncommon vascular lesions. Indian J Endocrinol Metab 2012; 16:962-971. [PMID: 23226643 PMCID: PMC3510968 DOI: 10.4103/2230-8210.103000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. MATERIALS AND METHODS From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. RESULTS Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. CONCLUSION There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - Siva Krishna Kota
- Department of Anesthesia, Central Security hospital, Riyadh, Saudi Arabia
| | - Lalit Kumar Meher
- Department of Medicine, MKCG Medical College, Berhampur, Orissa, India
| | - Sruti Jammula
- Department of Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Orissa, India
| | - Sandip Panda
- Department of Cardiology, JIPMER, Puducherry, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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Kota SK, Kota SK, Jammula S, Meher LK, Modi KD. Pheochromocytoma with inferior vena cava thrombosis: An unusual association. J Cardiovasc Dis Res 2012; 3:160-4. [PMID: 22629039 PMCID: PMC3354464 DOI: 10.4103/0975-3583.95375] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.
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Affiliation(s)
- Sunil K Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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