Management of acute limb ischemia related to underlying pheochromocytoma - PubMed (original) (raw)

Case Reports

Michael A Mederos et al. J Vasc Surg Cases Innov Tech. 2020.

Abstract

Acute limb ischemia (ALI) related to pheochromocytoma is rare. We describe a 69-year-old woman who presented with ALI due to a thromboembolic phenomenon from new-onset atrial fibrillation that was successfully treated with intra-arterial catheter-directed lysis and systemic anticoagulation. Further workup revealed a left adrenal mass and biochemical test results consistent with pheochromocytoma. The patient underwent a retroperitoneoscopic converted to open left adrenalectomy, splenectomy, and distal pancreatectomy because of severe inflammation in the retroperitoneum, probably from an adrenal or subcapsular renal hematoma secondary to systemic anticoagulation. Interval imaging before adrenalectomy for pheochromocytoma should be considered after thrombolysis and anticoagulation for ALI.

Keywords: Acute limb ischemia; Hemorrhage; Lysis; Pheochromocytoma.

© 2020 The Author(s).

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Figures

Fig 1

Fig 1

First angiogram demonstrating thromboembolic occlusion at the level of the left tibioperoneal trunk and left anterior tibial artery.

Fig 2

Fig 2

A, Interval angiogram demonstrating successful clot lysis but with evidence of microembolic showering distally. B, Final angiogram demonstrating restored flow.

Fig 3

Fig 3

Computed tomography (CT) of left adrenal pheochromocytoma and intraperitoneal hematoma. A, Non-contrast-enhanced phase with pheochromocytoma circled in blue. B, Venous phase with pheochromocytoma circled in blue. C, Delayed phase with pheochromocytoma circled in blue. D, Intraperitoneal hematoma circled in blue.

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