PMC8456100_01
Thorax radiography (A) and CT images [coronal view, (B); axial view, (C); sagittal view, (D)]. Diffuse bilateral patched consolidations with open bronchi inside and ground-glass opacities due to COVID-19 infection. Thorax radiography (E) and CT control images. Two weeks after treatment [coronal view, (F); axial view, (G); sagittal view, (H)], significant improvement of the pneumonia is observed.
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The chest X-ray showed converging diffuse condensations in both pulmonary fields, predominantly central, suggestive of evolutioned SARS-CoV-2 infection (Figure 1A). BP, the global respiratory insufficiency and a high suspicion of SARS-Cov-2 infection, a CT pulmonary angiogram was performed in order to rule out a pulmonary embolism. Bilateral patched consolidations with open bronchi inside and ground-glass opacities and no filling defects were observed in the pulmonary arteries (Figures 1B-D). Clinical and radiological improvements of the pneumonia were also observed (Figures 1E-H).
Coronal and axial CT views (A, B) show an 8 cm left adrenal tumor with a cystic component inside and partially calcified wall. Coronal and axial MRI views (C, D) reveal a left adrenal mass with a heterogeneous content (necrotic-cystic areas). Coronal and axial [18 F] DOPA PET/CT images (E, F) demonstrate intense and heterogeneous DOPA-uptake in the periphery of the mass (SUVmax of 20.9). These findings were compatible with the existence of pheochromocytoma with a cystic-necrotic-hemorrhagic component.
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The lower images of the scan revealed an adrenal left mass (8 x 7.4 cm) with a cystic component and a big calcification, suggestive of a hematoma or pseudocyst (Figures 2A, B ). These results were confirmed in a MRI (Figures 2C, D ). An 18-F-DOPA PET/CT was performed and revealed high aminoacidic metabolism in the peripheral area of the adrenal mass, with a central hypodense area with calcifications without metabolism, suggesting a pheochromocytoma with internal necrotic/cystic/hemorrhagic component (Figures 2E, F ).
Histological characteristics of the resected tumor. Hematoxylin eosin images that show intratumor hemorrhage and 60% of necrosis without vascular or peritumoral invasion.
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The histological analysis reported a pseudoencapsulated pheochromocytoma of 7 x 5 x 4 cm and 340 g, with focal calcification, intratumor hemorrhage and 60% of necrosis without vascular or peritumoral invasion (Figure 3).