Pheochromocytoma diagnosed after anticoagulation for atrial fibrillation ablation procedure: a giant in disguise.
Pheochromocytoma is a rare catecholamine-producing tumor, discovered incidentally in 50% of cases. We present the case of a 44-year-old male with a history of paroxysmal palpitations. Baseline ECG, transthoracic echocardiogram and ECG stress test showed no relevant alterations. Paroxysmal atrial fibrillation was detected on 24-hour Holter ECG. After antiarrhythmic therapy, the patient remained symptomatic, and was accordingly referred for electrophysiological study and atrial fibrillation ablation. Anticoagulation was initiated before the procedure. After ablation and still anticoagulated, he complained of hematospermia. The abdominal and pelvic imaging study showed a 10-cm left adrenal mass, predominantly cystic, compatible with pheochromocytoma, which was confirmed after biochemical tests (increased urine metanephrines and plasma catecholamines). Metaiodobenzylguanidine scintigraphy scanning confirmed localized disease in the adrenal gland, excluding other uptake foci. Following appropriate preoperative management, surgical resection of the giant mass was performed successfully and without complications.
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal. Electronic address: carlos.galvaobraga@gmail.com.
Carlos
C
Galvão Braga
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Sílvia
S
Ribeiro
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Juliana
J
Martins
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Carina
C
Arantes
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Vítor
V
Ramos
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
João
J
Primo
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Sónia
S
Magalhães
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Adelino
A
Correia
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation; D006801:Humans; D033162:Incidental Findings; D008297:Male; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis*
D000925:Anticoagulants
Atrial fibrillation; Feocromocitoma; Fibrilhação auricular; Hematoespermia; Hematospermia; Pheochromocytoma