Haouzi A, Danchin N, Renoult E, Selton-Suty C, Amrein D, Mathieu P, Kessler M, Cherrier F
Service de cardiologie B, CHU de Brabois-Nancy.
Arch Mal Coeur Vaiss. 1989 Jan;82(1):97-100.
We report an exceptional case of cardiac pheochromocytoma which raised problems of localization. A 30-year old man who for several years had been hypertensive was admitted for attacks of paroxysmal hypertension. Very high levels of urinary catecholamines suggested a diagnosis of pheochromocytoma, but no tumour was found at computerized tomography (CT) and metaiodobenzylguanidine (MIBG) scintigraphy. However, regional venous samplings detected two para-carotid phaeochromocytomas which were surgically removed. Thereafter, the symptoms persisted and investigations were resumed. As new regional venous samplings persisted and investigations were resumed. As new regional venous samplings showed high levels of catecholamines in the right atrium, a mediastinal and, chiefly, cardiac phaeochromocytomas was suspected. No tumour was visible at CT or ultrasonography and another MIBG scintigraphy proved negative. Coronary angiography showed a very large tumour behind the left atrium, well supplied by the circumflex artery and by a branch of the right coronary artery. The patient was operated upon and is now totally asymptomatic after a 9-month follow-up. This case emphasizes the value of invasive methods (i.e. regional venous sampling and coronary angiography) in the localization of this ectopic tumour. In most cases, however, phaeochromocytomas can be localized by MIBG scintigraphy.
我们报告了一例特殊的心脏嗜铬细胞瘤病例，该病例在定位方面存在问题。一名30岁的男性，多年来患有高血压，因阵发性高血压发作入院。尿儿茶酚胺水平极高提示嗜铬细胞瘤的诊断，但在计算机断层扫描（CT）和间碘苄胍（MIBG）闪烁扫描中均未发现肿瘤。然而，区域静脉采血检测到两个颈旁嗜铬细胞瘤，并通过手术切除。此后，症状持续存在，于是再次进行检查。由于新的区域静脉采血显示右心房儿茶酚胺水平升高，怀疑存在纵隔嗜铬细胞瘤，主要是心脏嗜铬细胞瘤。CT或超声检查均未发现肿瘤，再次进行的MIBG闪烁扫描结果为阴性。冠状动脉造影显示左心房后方有一个非常大的肿瘤，由回旋支动脉和右冠状动脉的一个分支提供丰富血供。该患者接受了手术，经过9个月的随访，目前完全无症状。该病例强调了侵入性方法（即区域静脉采血和冠状动脉造影）在这种异位肿瘤定位中的价值。然而，在大多数情况下，嗜铬细胞瘤可通过MIBG闪烁扫描定位。
