Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report

A 47-year-old Caucasian woman with a past medical history of hypertension presented for medical attention with left arm numbness. Doppler ultrasound showed an obstructing thrombus in her left axillary artery. She had symptom resolution after stent placement in her left axillary artery. A subsequent echocardiogram demonstrated a large intracardiac mass and abdominal computed tomography revealed a 7 cm mass between her spleen and left kidney. Labile blood pressure was noted during admission and she had very high levels of plasma and 24-hour urine catecholamines and metanephrines tests. A (123)I- metaiodobenzylguanidine scan showed intense uptake in the left abdominal mass. After adequate alpha blockage with phenoxybenzamine, laparoscopic tumor resection was performed without complications. She had normal metanephrines and complete symptom resolution afterwards. The intracardiac mass also disappeared with anticoagulation. All other endocrine laboratory abnormalities returned to normal after surgery.Arterial and ventricular thrombosis occurring in patients with pheochromocytoma is rare. A multi-disciplinary approach is necessary in caring for this type of patient. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of pheochromocytoma is the key to improving outcome.Pheochromocytoma is a rare disease occurring in less than 0.2 percent of patients with hypertension [1,2]. The classic presentation includes episodic hypertension, headaches and palpitations. However, many patients may have atypical presentations which often delay diagnosis. Even with classical presentations, the diagnosis is often missed for a number of years unless the patient is evaluated in a center experienced in this disease. Pheochromocytoma can have devastating consequences if not recognized and treated appropriately. Thrombolic events have been reported rarely in patients with pheochromocytoma and the exact mechanism of thrombosis is unclear [3-8]. He