PMC8285988_01
Radiologic examination of the patient. (a) Chest X-ray showing serious interstitial and alveolar oedema. (b and c) Chest posteroanterior shows interstitial and alveolar oedema improved. (d) CT revealed a left suprarenal tumour of 5.8 cm x 5.7 cm in size with necrosis (white arrow).
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Chest X-ray revealed severe interstitial and alveolar oedema (Figure 1a). Computed tomography revealed a left suprarenal tumour of 5.8 cm x 5.7 cm in size with central necrosis (Figure 1d).
Patient with PCC treatment by VA ECMO.
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As cardiocirculatory system collapse was anticipated and the underlying diagnosis was considered treatable, we decided to perform VA ECMO for this patient; she then underwent bedside percutaneous right femoral arterial (17 F) and venous (21 F) cannulation using the Seldinger technique VA ECMO (Figure 2).
Dynamic changes in blood pressure and dosage of vasopressors in the patient. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and dosages of norepinephrine (NE), epinephrine (E), dopamine (DA), and ECMO indicated. The dramatic cyclic blood pressure fluctuation during the catheter removed periods is particularly notable.
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Norepinephrine and adrenaline were withdrawn on the third day (Figure 3).
The histological diagnosis was pheochromocytoma of the adrenal medulla. (a) The tumor cells were distributed in nests under high magnification, with Sertoli cells and vascular sinuses visible around them. The tumor cells were polygonal and bubble-like with obvious nucleoli (HE x400). (b) The expression of S-100 in the Sertoli cells (IHC x400). (c) The expression of Syn in tumor cells (IHC x400). (d) The expression of CgA in tumor cells (IHC x400).
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At last, pathology confirmed phaeochromocytoma (Figure 4).