Authors: V. Dimov, M.D., Cleveland Clinic
Reviewer: S. Randhawa, M.D.
A 29-year-old CM is admitted to the hospital with CP and a large left-sided pleural effusion. Prior to admission, he had a thoracentesis at an OSH during which 1200 ml of fluids was removed. CT scan of the chest showed a retroperitoneal mass and pleural thickening.
Negative prior to the OSH admission
Metoprolol, furosemide, acetaminophen, oxycodone ER, pregabalin, phenoxybenzamine, esomeprazole
Lungs: decreased sounds L lung
Heart: Tachycardic, no m/r/g
Abdomen: Soft, non-tender. Bowel sounds normal. No masses or organomegaly
Extremities: + 3 BLE edema
Plasma catecholamines in pheochromocytoma
Urine catecholamines in pheochromocytoma
The patient was diagnosed with right paraganglioma which is an extra-adrenal pheochromocytoma. Thoracotomy and lung biopsy showed angiosarcoma. Peripheral edema was due to IVC compression by the tumor.
General surgery and oncology services were consulted and an exploratory laparotomy was recommended.
What happened next?
He was started on preoperative alpha and beta-blockers 2 weeks before the surgery. Laparotomy revealed inoperable retroperitoneal tumor with known lung angiosarcoma and paraganglioma. The oncology service will discuss options for chemotherapy with the patient and his family.
Paraganglioma and Angiosarcoma
Adrenal Histopathology: Pheochromocytoma, on YouTube.