Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China.
Department of Cardiovascularology, The Affiliated AnQing Municipal Hospital of Anhui Medical University, 352th, Renming Road, AnQing, 246003, China.
BMC Anesthesiol. 2022 Jul 11;22(1):212. doi: 10.1186/s12871-022-01766-7.
Patients with pheochromocytomas are often diagnosed with acute myocardial infarction (AMI) due to initial symptoms of palpitations and chest tightness. We describe a case of AMI syndrome where a giant paraganglioma was unexpectedly identified. The anesthetic management of the paraganglioma resection was challenging and complex.
A 66-year-old woman was admitted to the emergency department for complaints of palpitations, chest tightness and vomiting. A laboratory test revealed that troponin I and N-terminal pro-brain natriuretic peptide levels were dramatically increased. Emergency percutaneous coronary angiography (CAG) showed normal coronary arteries. In addition, the serum levels of free catecholamines were increased, and computed tomography and magnetic resonance imaging revealed a heterogenous mass lesion in the right retroperitoneal. All of this ultimately confirmed the diagnosis of pheochromocytoma. After three weeks of careful preoperative preparation by a multidisciplinary team, and an anesthesiologist team develops detailed perianesthesia management strategies to maintain hemodynamics and blood glucose stability and regulate acid-base balance, pheochromocytoma resection was performed successfully. About 2 weeks later, the patient was discharged healthy. A postoperative pathology test confirmed paraganglioma.
To our knowledge, giant pheochromocytoma resection is a complex challenge for the anesthesiologists, this clinical case may supply a thoughtful experience for anesthetic management in the resection of giant pheochromocytomas. Adequate preoperative evaluation and prudent perianesthesia management by anesthesiologists are important guarantees for patients to obtain a good prognosis and discharge healthily.
由于最初的心悸和胸闷症状，患有嗜铬细胞瘤的患者常被诊断为急性心肌梗死（AMI）。我们描述了一例 AMI 综合征病例，其中意外发现了巨大的副神经节瘤。副神经节瘤切除术的麻醉管理具有挑战性且复杂。
一名 66 岁女性因心悸、胸闷和呕吐到急诊科就诊。实验室检查显示肌钙蛋白 I 和 N 端脑利钠肽前体水平显著升高。紧急经皮冠状动脉造影（CAG）显示正常冠状动脉。此外，血清游离儿茶酚胺水平升高，计算机断层扫描和磁共振成像显示右侧腹膜后混杂肿块病变。所有这些最终都确诊为嗜铬细胞瘤。经过多学科团队三周的精心术前准备，麻醉师团队制定了详细的围手术期管理策略，以维持血流动力学和血糖稳定，调节酸碱平衡，成功进行了嗜铬细胞瘤切除术。大约两周后，患者健康出院。术后病理检查证实为副神经节瘤。
据我们所知，巨大嗜铬细胞瘤切除术对麻醉师来说是一个复杂的挑战，这个临床病例可能为巨大嗜铬细胞瘤切除术的麻醉管理提供有益的经验。麻醉师进行充分的术前评估和谨慎的围手术期管理是患者获得良好预后和健康出院的重要保证。
