Salameh Mohammed, Swizer Katelyn, Patel Abhishek P, Petrescu Matei
Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Pediatric Hematology and Oncology, University of Michigan, Ann Arbor, USA.
Cureus. 2025 Feb 26;17(2):e79696. doi: 10.7759/cureus.79696. eCollection 2025 Feb.
A previously healthy 16-year-old female presented with acute onset of signs and symptoms of headache, nausea, sweating, abdominal pain, palpitations, chest pain, hypertension, and tachycardia. The patient was admitted to the pediatric critical care unit and rapidly progressed to cardiorespiratory failure, necessitating veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a life-saving measure. After three days of ECMO support, complicated by arterial thrombi to the left lower limb, necessitating below-knee amputation, the patient was weaned off ECMO and ventilator support. A renal ultrasound was performed, as the patient had significant hypertension, which revealed a left para-renal mass. A biopsy of the mass, elevated plasma/urine catecholamine, and genetic testing confirmed the diagnosis of paraganglioma-pheochromocytoma (PG-PH) syndrome. A diagnosis of PG/PH was made, and a catecholamine surge due to the tumor was deemed the cause of the cardiac arrest. This is a rare disease, and a presentation with cardiorespiratory arrest has not been reported in children prior to this case. Our case highlights the importance of early identification of rare cases using history and examination, along with screening of those at high risk. It also shines a light on the importance of VA ECMO support in severe cases that present with cardiac arrest.
一名既往健康的16岁女性，出现头痛、恶心、出汗、腹痛、心悸、胸痛、高血压和心动过速等急性症状和体征。患者被收入儿科重症监护病房，并迅速进展为心肺衰竭，需要进行静脉-动脉体外膜肺氧合（VA ECMO）作为挽救生命的措施。在接受ECMO支持三天后，出现左下肢动脉血栓形成的并发症，需要进行膝下截肢，随后患者脱离了ECMO和呼吸机支持。由于患者患有严重高血压，进行了肾脏超声检查，结果显示左肾旁有一个肿块。对该肿块进行活检、血浆/尿液儿茶酚胺水平升高以及基因检测，确诊为副神经节瘤-嗜铬细胞瘤（PG-PH）综合征。诊断为PG/PH，肿瘤引起的儿茶酚胺激增被认为是心脏骤停的原因。这是一种罕见疾病，在此病例之前，儿童中尚未有出现心肺骤停的报道。我们的病例强调了通过病史和检查早期识别罕见病例以及对高危人群进行筛查的重要性。它还凸显了VA ECMO支持在出现心脏骤停的严重病例中的重要性。
