Atypical presentation of pheochromocytoma as acute ischemic stroke and pulmonary embolism, a case report

Background Pheochromocytoma is a rare catecholamine‐secreting tumor that often presents with symptoms such as hypertension, palpitations, and sweating due to excessive hormone production. In some cases, the catecholamine‐induced vasoconstriction and hypercoagulability associated with pheochromocytomas can lead to cerebrovascular accidents and venous thrombosis. We report a rare case of pheochromocytoma in a middle‐aged man who initially presented with a stroke and later developed a pulmonary embolism. Case Presentation A 44‐year‐old gentleman presented with sudden right‐sided weakness, numbness, and slurred speech, lasting for 6 h. His medical history included hypertension, for which he was on bisoprolol. On examination, he exhibited right‐sided facial weakness, asymmetric smile, and motor weakness (0/5 on the right). Brain computed tomography angiography revealed an infarction in the left middle cerebral artery territory, complicated by hemorrhagic transformation. Seven days later, he developed severe left‐sided abdominal and chest pain, sweating, and left upper quadrant tenderness. His labs showed leukocytosis, and chest radiography raised suspicion of pulmonary embolism (PE). A computed tomography (CT) pulmonary angiogram confirmed thrombi in the left lower lobe with moderate left pleural effusion. Abdominal ultrasound revealed a non‐vascular mass near the left kidney, which was later identified as a 3.6 cm × 4.3 cm adrenal mass on CT. Biochemical tests confirmed pheochromocytoma. An FDG‐PET scan suggested an intense FDG‐avid left adrenal mass. Conclusion This case demonstrates the rare association between pheochromocytoma and thrombotic events. Atypical presentations can complicate diagnosis, highlighting the need for early testing. Surgery remains the primary treatment, with long‐term follow‐up due to the risk of recurrence.