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Pheochromocytoma with metastases to the left celiac lymph node

USU Teaching File MUTF - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Pheochromocytoma with metastases to the left celiac lymph node

History: 30 yo with no past medical history who felt dehydrated in Iraq in May. BP measurement was 250/140 and he was evacuated to Landstuhl for stabilization. He noted a prior history of headaches, flushing, shortness of breath, arrhythmias, fainting and dyspnea upon closer questioning, but no nausea, vomiting, chest pain or palpitations. He was started on labetolol initially, and then switched to prazosin after CT and labs diagnosed pheochromocytoma. He was eventually transferred to WRAMC surgical oncology for adrenalectomy and pheochromocytoma excision.

Findings: Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders. There is no indication of a “claw” sign. In-111 octreotide uptake fusion study demonstrates an area of increased uptake corresponding to the pararenal mass, and another area of increased uptake corresponding to a celiac lymph node.

Ddx: •Adenoma (50%–80%)–90% Nonfunctioning– 10% Functioning (Cushing syndrome or aldosteronoma)•Cyst and pseudocysts (5%–20%) •Pheochromocytoma (5%–15%) •Adrenocortical carcinoma (2%–10%) •Metastatic (0%–10%) •Adrenal hyperplasia (5%–10%) •Myelolipoma and lipoma (5%–15%) •Ganglioneuroma (0%–5%) •Hematoma, infection (Histo), lymphoma, neuroblastoma, granuloma (rare)

Exam: 24hr VMA 107.6 (0-10 normal), epinephrine 170 (.5-20), norepinephrine 460 (15-80).

No MeSH data available.


Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders.  There is no indication of a “claw” sign.
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MPX1683_synpic16677: Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders. There is no indication of a “claw” sign.


Pheochromocytoma with metastases to the left celiac lymph node

USU Teaching File MUTF - MedPix

Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders.  There is no indication of a “claw” sign.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1683&req=5

MPX1683_synpic16677: Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders. There is no indication of a “claw” sign.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Pheochromocytoma with metastases to the left celiac lymph node

History: 30 yo with no past medical history who felt dehydrated in Iraq in May. BP measurement was 250/140 and he was evacuated to Landstuhl for stabilization. He noted a prior history of headaches, flushing, shortness of breath, arrhythmias, fainting and dyspnea upon closer questioning, but no nausea, vomiting, chest pain or palpitations. He was started on labetolol initially, and then switched to prazosin after CT and labs diagnosed pheochromocytoma. He was eventually transferred to WRAMC surgical oncology for adrenalectomy and pheochromocytoma excision.

Findings: Abdominal CT demonstrates a mass adjacent to the left kidney with distinct borders. There is no indication of a “claw” sign. In-111 octreotide uptake fusion study demonstrates an area of increased uptake corresponding to the pararenal mass, and another area of increased uptake corresponding to a celiac lymph node.

Ddx: •Adenoma (50%–80%)–90% Nonfunctioning– 10% Functioning (Cushing syndrome or aldosteronoma)•Cyst and pseudocysts (5%–20%) •Pheochromocytoma (5%–15%) •Adrenocortical carcinoma (2%–10%) •Metastatic (0%–10%) •Adrenal hyperplasia (5%–10%) •Myelolipoma and lipoma (5%–15%) •Ganglioneuroma (0%–5%) •Hematoma, infection (Histo), lymphoma, neuroblastoma, granuloma (rare)

Exam: 24hr VMA 107.6 (0-10 normal), epinephrine 170 (.5-20), norepinephrine 460 (15-80).

No MeSH data available.