Endomyocardial biopsy in a patient with hemorrhagic pheochromocytoma presenting as inverted Takotsubo cardiomyopathy
Endomyocardial biopsy in a patient with hemorrhagic pheochromocytoma presenting as inverted Takotsubo cardiomyopathy
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DOI：
10.1007/s00380-012-0247-4
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发表时间：
2013-03-01
影响因子：
1.5
通讯作者：
Ikeda, Uichi
中科院分区：
文献类型：
--
作者：
Iio, Kohei;Sakurai, Shunpei;Ikeda, Uichi
一名29岁女性患者因心力衰竭和肺水肿出现休克和呼吸困难。超声心动图显示过度收缩仅限于左心室心尖部，基底室和中心室运动不能，经急诊左心室造影证实。该发现诊断为倒置型Takotsubo心肌病。腹部电脑断层扫描显示肿瘤在左肾上腺与中央低密度区，血浆和尿中的儿茶酚胺显着升高。综上所述，这些结果表明存在出血性嗜铬细胞瘤。入院当天的极急性期心肌活检显示嗜中性粒细胞浸润和收缩带坏死，这与先前报告的无嗜铬细胞瘤的特发性Takotsubo心肌病急性期的病理学无法区分。在这个病例中，嗜铬细胞瘤的诊断在7周后通过手术切除左侧肾上腺并在嗜铬细胞瘤中心大出血而得到证实。该病例与特发性Takotsubo心肌病病例之间的子宫内膜异位症病理学显著相似，强烈表明儿茶酚胺过量是Takotsubo心肌病伴或不伴嗜铬细胞瘤的常见原因。
A 29-year-old female patient presented with shock and dyspnea due to heart failure and pulmonary edema. Echocardiography indicated excessive contraction limited to the left ventricular apex and akinesis of the basal and middle ventricle, which were confirmed by emergency left ventriculography. The finding was diagnostic of inverted Takotsubo cardiomyopathy. An abdominal computed tomography scan showed a tumor in the left adrenal gland with a central low-density area, and the plasma and urinary catecholamines were strikingly elevated. Taken together, these findings suggested the presence of a hemorrhagic pheochromocytoma. A myocardial biopsy in the very acute stage on the day of admission revealed neutrophilic infiltration and contraction-band necrosis, which was indistinguishable from the previously reported pathology in the acute phase of idiopathic Takotsubo cardiomyopathy without pheochromocytoma. The diagnosis of pheochromocytoma in this case was confirmed 7 weeks later by surgical removal of the left adrenal gland with massive hemorrhage at the center of the pheochromocytoma. The marked similarity of the endomyocardial pathology between this case and cases with idiopathic Takotsubo cardiomyopathy strongly points to catecholamine excess as a common causality for Takotsubo cardiomyopathy with or without pheochromocytoma.