Kirsten Brukamp, MD, Simin Goral, MD, Raymond R. Townsend, MD, Frank E

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Rapidly Reversible Cardiogenic Shock as a Pheochromocytoma Presentation Kirsten Brukamp, MD, Simin Goral, MD, Raymond R. Townsend, MD, Frank E. Silvestry, MD, Drew A. Torigian, MD, MA The American Journal of Medicine Volume 120, Issue 9, Pages e1-e2 (September 2007) DOI: 10.1016/j.amjmed.2006.08.031 Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 1 The patient’s abdominal computed tomography (CT) examination demonstrates a left adrenal mass. The axial contrast-enhanced CT image through the upper abdomen with oral and intravenous contrast reveals a well-circumscribed mildly heterogeneous 3.2 cm mass (arrow) within the left adrenal gland, which did not contain fat. Major differential diagnostic considerations include adrenal metastasis, pheochromocytoma, and adenoma. There was no demonstrable gastrointestinal pathology, and the intraabdominal structures, such as aorta, liver, spleen, pancreas, and kidneys, appeared normal on cross-sectional imaging. The American Journal of Medicine 2007 120, e1-e2DOI: (10.1016/j.amjmed.2006.08.031) Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 2 A heterogeneous, non-lipid-containing left adrenal mass is confirmed on magnetic resonance imaging (MRI). The axial heavily T2-weighted MR image through the upper abdomen, performed after the CT scan, demonstrates areas of mixed intermediate and high signal intensity within the non-lipid-containing adrenal mass (arrow). Chemical shift imaging did not reveal the presence of microscopic lipid (not shown). A heterogeneous T2-weighted signal intensity and arterial phase enhancement were suggestive of a pheochromocytoma. The American Journal of Medicine 2007 120, e1-e2DOI: (10.1016/j.amjmed.2006.08.031) Copyright © 2007 Elsevier Inc. Terms and Conditions