Author + information
- Praveen Badrinarayan Pawal1
Patient initials or identifier number
Relevant clinical history and physical exam
Background: Mrs. N, 33 Years-old female, residing at Hyderabad. Presented here with history of retrosternal chest Pain associated with heaviness and sweating for 2 days. Excertional Shortness of breath NYHA class III BP 170/100 HR 94/MIN CVS S1S2.
Normal RS Clear
Past history: She is hypertensive for 2 year on telmisarten and amlodepine .complaint of flushing headache and palpitation. This episodes last for 20-30 min and twice weekly for 1 year. ECG and USG Abdomen done
Relevant test results prior to catheterization
ECG revealed ST Depression II/III AVF
2D ECHO revealed LAD tertiary akinetic moderate LV Systolic Dysfunction
HB 13GM /DL CREATININE 0.90 MG SERUM K 4.2 SODIUM 136 meq
Ultrasound Abdomen Revealed Large Suprarenal Mass
The CECT Abdomen Revealed Mass 9.0 – 3.6 x 3.6, Large lobulated, roughly oval, Mixed soft tissue density mass
Above upper pole of Left Kidney
Portal Venous Phase: Enhancement upto 176 HU.
Delayed Phase: Washout up to 76 H s/o pheochromocytoma.
Relevant catheterization findings
Cathater tiger 5F
LAD : Type III vessel proximal lad 90%concentric tubular stenosis mid and distal lad normal .
LCX : Normal
RCA: Dominant system normal
The patient was pretested with ticagrelor 180 mg and ecosprin 325 mg and 7200 unit un fraction heparin was given. diagnostic catheter was exchange with guide XB 3.0 X 6 F.
The guide wire balanced middle weight was pass through lesion lesion, lesion measured by QCA.
Stent 3.5 x 18 mm abluminus direct stent done, the stent was dilated at 12 atmosphere pressure for 30 seconds good result TIMI III FLOW was achieved
No post procedural dilation was done
The procedure was uneventful and the patient tolerated procedure well.
A 33 years-old young female presented with NSTEMI, The primary pci to lad was done,patient later diagnosed to have pheochromocytoma. Unfortunately, our patient initially treated β-adrenoreceptor blocker which aggravated her symptoms,which lead us for further evolution and diagnosis of pheochromcytoma. Furthermore, patient managed with alpha-blocker and beta-blocker and plan for surgery three month post pci.
It is unclear how long this patient’s tumor was present. Prompt identification of any of the several unusual features in this case may point to the appropriate diagnosis and timely treatment of pheochromocytoma.