Phaeochromocytoma and cardiomyopathy

Phaeochromocytoma is a rare endocrine tumour. There are several reports dealing with isolated complications due to the systemic effects of its metabolites. We would like to report a patient seen at our institution with a right adrenal phaeochromocytoma who had many associated complications: cardiomyopathy with congestive heart failure, intracavitary left ventricular thrombus, invasion of the inferior vena cava and peripheral vascular embolus. A discussion of the findings and review of the literature is presented stressing the fact that cardiomyopathy may be the initial presentation in these patients, a situation not reported in the radiological literature. A 23-year-old man was admitted to the hospital with a history of fever, chills, night sweats, anorexia, arthralgias and a 10 lb weight loss over a period of two weeks. He also had right pleuritic pain, a productive cough and occasional haemoptysis. He had a history of gastrectomy at the age of 13 for peptic ulcer disease, and crossed fused ectopia with repeated urinary tract infections. Physical examination revealed an ill, diaphoretic patient with shortness of breath and tachypnoea (40/min). Temperature: 99°F. Blood pressure was normal. Bilateral friction rubs were present and there was clinical evidence of cardiomegaly and congestive heart failure. The ECG showed tachycardia, some premature ventricular beats and left axis deviation. The initial diagnosis was pneumonia, myocarditis and congestive heart failure. The chest film at that time showed generalised cardiomegaly and congestive heart failure (Fig. 1a). An echocardiogram showed dilatation of the left ventricle and diffuse hypokinesia consistent with myocardial disease.