Acute dyspnoea resulting from pulmonary oedema as the first sign of a phaeochromocytoma

The day after undergoing neck dissection, a 42-year-old woman developed acu te dyspnoea due to pulmonary oedema. Measurements with a Swan-Ganz catheter revealed not only cardiac depression but also a greatly increased peripher al vascular resistance: 5,400 dyn.s.cm(-5)/m(2). A phaeochromocytoma with a cute cardiac failure leading to pulmonary oedema was considered. Treatment with alpha- and beta -blockers was complicated by severe hypotension and la ter ventricular fibrillation. Mechanical ventilation was required for 6 day s following resuscitation. Investigation of the urine subsequently showed g reatly increased catecholamine concentrations, while imaging revealed bilat eral adrenal tumours. Our case history shows that acute pulmonary oedema ma y be the presenting manifestation of a phaeochromocytoma. The pulmonary oed ema resulted partly from backward failure following tachycardia, myocyte ne crosis and the greatly increased peripheral vascular resistance, and partly from increased permeability of the capillary network in the lungs. Copyrig ht (C) 2001 S. Karger AG, Basel.