A rescued case of extra-adrenal pheochromocytoma complicated by cardiogenic shock, acute heart failure, and catecholamine cardiomyopathy

A 55-year-old woman was admitted to our hospital with worsening back pain after her daughter's wedding. Physical examination on admission demonstrated a heart rate of 98/min and blood pressure of 91/70 mmHg. ECG showed ST segment elevation in leads II, III, and aVF. Chest X-ray demonstrated infiltrative shadows in the right upper lobe, and echocardiography demonstrated extensive akinesis of the anterolateral, apical, and diaphragmatic segments with a global ejection fraction of 18%. Abdominal CT demonstrated a non-uniform mass measuring 6 cm in diameter with rich blood flow in the porta hepatis. Worsening pulmonary shadow just after admission caused hypotension and shock, which required emergency mechanical ventilation in the intensive care unit. The control of hemodynamics was poor and systolic blood pressure was 80-90 mmHg even with cathecholamine and vasopressin; PaO₂ was 90-100 Torr following diuretics, afterload-reducing medication, and mechanical ventilation. After two weeks of intensive care therapy, surgery was performed on day 38 under a pathological diagnosis of paraganglioma. The patient was ambulatory when discharged home on day 46.