IODINE-123-MIBG IMAGING IN PHEOCHROMOCYTOMA WITH CARDIOMYOPATHY AND PULMONARY-EDEMA

We encountered a patient with pheochromocytoma associated with a catec holamine-induced cardiomyopathy that developed recurrently bilateral a nd unilateral pulmonary edema. The diagnosis of pheochromocytoma was m ade by elevated plasma catecholamine levels and intense tumor [(123)]M IBG uptake and was confirmed at the time of surgery. The patient showe d reduced myocardial [(123)]MIBG uptake with left ventricular dysfunct ion, and endomyocardial biopsy findings were consistent with the diagn osis of catecholamine-induced cardiomyopathy. After tumor resection, p lasma levels of catecholamine were normalized, and pulmonary edema nev er recurred, although cardiac dysfunction did not show an improvement on echocardiography, Myocardial and lung [(123)]MIBG uptake increased when compared to uptake levels on preoperative scans, but myocardial u ptake was still below normal. These findings indicated that over-secre ted catecholamines influenced both the heart and lungs, Pheochromocyto ma can induce cardiac and lung injuries, and [(123)]MIBG scanning may contribute not only to tumor characterization but also to assessing an d monitoring the influence of catecholamines on the heart and lungs.