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(Circulation. 1998;97:1993-1994.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Malignant Cardiac Pheochromocytoma With Bone Metastases

Akikazu Nomura, MD; Shigeo Kakinoki, MD; Miri Fujita, MD; ; Akira Kitabatake, MD

Correspondence to Akikazu Nomura, MD, Department of Cardiovascular Medicine, Hokkaido University, School of Medicine, Kita 15, Nishi 7, Sapporo, 060 Japan.

A 25-year-old man was referred to our hospital because of an abnormal shadow in the mediastinum, detected by gallium scintigraphy, and bone fractures. Three weeks before admission, he experienced severe neck pain while practicing golf at a driving range. The next morning, he was brought to a neurosurgeon by ambulance because the pain had become more severe and he was beginning to lose consciousness. A cervical radiograph showed a C4 compression fracture, and ^99mTc bone scintigraphy depicted abnormal shadows in the left frontal bone, C2, C4, Th10, and right 8 rib. Gallium scintigraphy suggested a tumor in the mediastinum (Fig 1).

View larger version (141K): [in this window] [in a new window]   Figure 1. Left, 99mTc bone scintigraphy. Abnormal shadows can be seen at left frontal bone, C2, C4, Th10, and right 8 rib. Right, Gallium scintigraphy. Tumor is located in mediastinum.

Physical findings at admission, including blood pressure of 110/62 mm Hg, were within normal limits except for a pulse rate of 110 bpm. Echocardiography, MRI, and spiral CT showed a tumor located at the roof of the atria and penetrating into the right atrium and right ventricle (Fig 2). The size of the tumor was estimated to be 8x6x8 cm. Plasma norepinephrine was 3010 pg/mL (normal, 40 to 350 pg/mL), plasma epinephrine was 25 pg/mL (normal, <120 pg/mL), and plasma dopamine was 9720 pg/mL (normal, <30 pg/mL). Urine norepinephrine was 965 µg/d (normal, 10 to 150 µg/d), urine epinephrine was 24 µg/d (normal, <12 µg/d), and urine dopamine was 11 490 µg/d (normal, 130 to 1200 µg/d). . . . [Full Text of this Article]

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