PMC9252594_01
Representative images of patient 1. Contrast-enhanced CT on admission showed right adrenal mass (A). ECG on the 3rd day showed tachycardia (B). CT scan on the 3rd day showed pheochromocytoma rupture and hemorrhage (C). Reexamination enhanced CT showed retroperitoneal hematoma on the 4th day (D).
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Subsequent CT showed a 7.1 cm x 6.6 cm, round, right adrenal mass (Figure 1A). During hospitalization, the pain was aggravated and spread throughout the abdomen, accompanied by severe fluctuations in blood pressure and heart rate (Figure 1B). CT reexamination showed pheochromocytoma rupture and hemorrhage (Figure 1C), and the retroperitoneal hematoma was increased after 1 day (Figure 1D).
PMC9252594_02
Representative images of patient 2. ECG showed tachycardia when admission in ICU (A). Enhanced CT showed left right adrenal mass (B). Curves of leukocyte count, troponin, metanephrine and normetanephrine showed recurrent crisis happened several times (C). Chest X-ray changes after admission in ICU (D). Laparoscopic surgery with ECMO support (E).
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Her blood pressure fluctuated from 99/74 to 144/115 mmHg, and her pulse rate was 130-140 bpm (Figure 2A). CT showed a 6.6 cm x 5.7 cm, round, central necrosis adrenal mass with an enhancing rim on the left side (Figure 2B). All indices improved significantly, and the tracheal catheter was removed on the 6th day after admission to the ICU (Figure 2C). However, her condition worsened 2 days later when her leukocyte count (26.34 x 109/L) and plasma MNs (metanephrine, 2,466.31 ng/L; normetanephrine, 3,214.03 ng/L) significantly increased (Figure 2C). Furthermore, her lung condition worsened due to recurrent acute pulmonary edema and fibrosis (Figure 2D). Because of the trauma of open surgery and literature reports, we chose to use the laparoscopy approach first and prepared to open on the 28th day (Figure 2E).