POSTOPERATIVE ACUTE PULMONARY-EDEMA - A RARE PRESENTATION OF PHEOCHROMOCYTOMA

A 39-year-old white female underwent an uneventful vaginal hysterectom y for dysfunctional bleeding. Evaluating a mild aortic insufficiency m urmur preoperatively an echocardiogram revealed normal left ventricula r wall motion and function. Postoperatively the patient developed seve re abdominal nain. acute hypertension (200/100 mmHg), and sinus tachyc ardia. Within minutes she decompensated into acute pulmonary edema. EC G demonstrated acute ST segment elevation in the precordial leads cons istent with acute infarction. Emergency left heart catheterization sho wed normal coronary vessels with severe left ventricular dysfunction. An abdominal ultrasound was obtained, revealing a right adrenal mass. Plasma epinephrine was 334, norepinephrine 34,543 pg/ml; urine epineph rine 45, urine norepinephrine 2,137 mu g/24 hours. She was started on prazosin and nifedipine sustained release with good blood pressure con trol. Four days later, an echocardiogram demonstrated the left ventric ular wall motion reverting to normal, The adrenal tumor was subsequent ly resected successfully. Acute pulmonary edema causing dilated cardio myopathy is a rare complication of pheochromocytoma that has been seld omly reported. A progressive fatal course is common: reversibility and survival depend on identifying and removing the pheochromocytoma.