Fahmy N, Assaad M, Bathija P, Whittier F C
Medical College of Virginia, Department of Medicine, MCV Station, Richmond, USA.
Clin Nephrol. 1997 Aug;48(2):122-4.
A 39-year-old white female underwent an uneventful vaginal hysterectomy for dysfunctional bleeding. Evaluating a mild aortic insufficiency murmur preoperatively an echocardiogram revealed normal left ventricular wall motion and function. Postoperatively the patient developed severe abdominal pain, acute hypertension (200/100 mmHg), and sinus tachycardia. Within minutes she decompensated into acute pulmonary edema. ECG demonstrated acute ST segment elevation in the precordial leads consistent with acute infarction. Emergency left heart catheterization showed normal coronary vessels with severe left ventricular dysfunction. An abdominal ultrasound was obtained, revealing a right adrenal mass. Plasma epinephrine was 334, norepinephrine 34,543 pg/ml; urine epinephrine 45, urine norepinephrine 2,137 micrograms/24 hours. She was started on prazosin and nifedipine sustained release with good blood pressure control. Four days later, an echocardiogram demonstrated the left ventricular wall motion reverting to normal. The adrenal tumor was subsequently resected successfully. Acute pulmonary edema causing dilated cardiomyopathy is a rare complication of pheochromocytoma that has been seldomly reported. A progressive fatal course is common: reversibility and survival depend on identifying and removing the pheochromocytoma.
一名39岁的白人女性因功能失调性子宫出血接受了一次顺利的阴道子宫切除术。术前评估轻度主动脉瓣关闭不全杂音时，超声心动图显示左心室壁运动和功能正常。术后患者出现严重腹痛、急性高血压（200/100 mmHg）和窦性心动过速。几分钟内，她病情恶化，发展为急性肺水肿。心电图显示胸前导联急性ST段抬高，符合急性梗死表现。紧急左心导管检查显示冠状动脉血管正常，但存在严重左心室功能障碍。进行了腹部超声检查，发现右侧肾上腺有一个肿块。血浆肾上腺素为334，去甲肾上腺素为34,543 pg/ml；尿肾上腺素为45，尿去甲肾上腺素为2,137微克/24小时。开始给予哌唑嗪和硝苯地平缓释片治疗，血压得到良好控制。四天后，超声心动图显示左心室壁运动恢复正常。随后成功切除了肾上腺肿瘤。急性肺水肿导致扩张型心肌病是嗜铬细胞瘤罕见的并发症，鲜有报道。通常会有一个进行性的致命病程：可逆性和生存取决于能否识别并切除嗜铬细胞瘤。
