PMC10327548_01
(A) ECG of the admitted patient; (B) ECG of patients after treatment with phenoxybenzamine. (C) Lung CT examination at admission shows that bronchiectasis of the lower lobe of the left lung is associated with infection, bilateral lung inflammation (red arrow). (D) Pulmonary CT on the second day after the addition of phenbenamine, displays Bronchiectasis of the lower lobe of the left lung with slight relief of infection (red arrow). (E) Preoperative lung CT re-examination depicts that the degree of bronchiectasis with infection in the lower lobe of the left lung is slightly less than that of the previous one (red arrow). (F) Abdominal enhanced CT manifests that mass high density mixed density shadow can be observed in the left middle and upper abdomen; the maximum level is about 7.7 cm x 9.4 cm (red arrow). (G) Preoperative abdominal CT review, appearing roughly similar to the previous image (red arrow). (H) Systolic period in the apical two chamber (A2C) view: displays the apical wall of left ventricle becomes thinner; outward bulg and reduction of amplitude of motion (red arrow).
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F1
On admission, the ECG (Figure 1) showed elevated ST segments in lead V1-V6. LV apex was slightly dilated outward. Lung computerized tomography (CT) revealed trachea and sputum retention, left lower lung bronchiectasis with infection and bilateral lung inflammation (Figure 1). In addition, an enhanced abdominal CT scan (Figure 1) confirmed the presence of a space-occupying lesion in the posterior peritoneal region of the left mid-epigastric region, which was a neurogenic tumor. After adjusting the treatment protocol, the liver and kidney function of the patient and the elevated ST segment of the ECG returned to normal (Figure 1). The lung re-CT examination displayed bilateral lungs had less inflammation than previously (Figure 1); thus, we downgraded meropenem to piperacillin-tazobactam sodium. Other examinations also met surgical requirements (Figure 1).
Phenoxybenzamine was used from the 7th day. The red arrow indicates the start of the treatment with phenoxybenzamine, and the black arrow indicates the increase of the dosage of phenoxybenzamine. (A) White blood cell count. (B) procalcitonin count. (C) Blood urea nitrogen and creatinine levels. (D) Liver function tests, aspartate transaminase, and alkaline phosphatase. (E) Daily maximum temperature. (F) Daily maximum systolic and diastolic blood pressure. (G) Heart rate.
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F2
TID) and metoprolol succinate (47.5 mg, BID). The important laboratory and physical alterations throughout the entire treatment process are detailed in Figure 2.
Pathological image. (A) HE staining of pheochromocytoma; the tumor is positive for chromogranin-A (B) and synaptophysin (C); S100 shows a well-developed sustentacular cell network (D); The nontumorous elements (e.g. endothelial cells, stromal cells, etc.); SDHB remains positive (E); Ki67 (+2%) (F). Pheochromocytoma is positive for SF-1 (G) and CK-pan (H).
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F3
Adrenal pheochromocytoma was confirmed by resection and pathological examination (Figure 3, Pathology).