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(Circulation. 1999;100:2387.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Somatostatin-Receptor Scintigraphy Identifies a Cardiac Pheochromocytoma

Yves Cottin, MD; Alina Berriolo, MD; France Guy, MD; Michel Toubeau, MD; Ivan Belleville, MD; Roger Brenot, MD; François Brunotte, MD; Jean Eric Wolf, MD

From the Department of Cardiology, the Division of Nuclear Medicine, the Department of Radiology, the Division of Endocrinology, and the Division of Magnetic Resonance, Centre Hospitalier Universitaire et Centre G.F. Leclerc, Dijon, France.

Correspondence to Dr Yves Cottin, Service de cardiologie II, Centre Hospitalier Universitaire, 2 boulevard Maréchal de Lattre de Tassigny, 210134 Dijon Cedex, France.

A17-year-old woman had paroxysmal hypertension. Very high levels of urinary catecholamines suggested a diagnosis of pheochromocytoma (urinary norepinephrine 27 600 nmol/24 hours, normal <485 nmol/24 hours; urinary normetanephrine 37 607 nmol/24 hours, normal <2000 nmol/24 hours), but no adrenal tumor was found on the abdominal CT scan. Metaiodobenzylguanidine (MIBG) whole-body scintigraphy was performed, and no abnormal uptake was observed. To locate the tumor, ¹¹¹In-labeled pentetreotide somatostatin-receptor scintigraphy was performed. An intense focal uptake was seen in the thoracic area (Figure 1). An intravenous injection of ^99mTc microspheres was used to label the lungs. The subsequent double-isotope tomoscintigraphy located the tumor beside the right lung in the inferior mediastinum (Figure 1).

View larger version (111K): [in this window] [in a new window]   Figure 1. Whole-body scintigraphy 48 hours after the administration of 185 MBq of 111In-pentetreotide. Anterior and posterior views reveal a focal uptake above the liver. A transaxial slice acquired by double-isotope single photon emission CT shows that the tumor labeled with 111In pentetreotide (red) is in the mediastinum beside the right lung, which is labeled with 99mTc microspheres (green).

ECG-gated MRI and transesophageal echocardiography gave further information about the anatomic extent of the tumor. The pheochromocytoma was located adjacent to the right atrium (Figure 2).

View larger version (74K): [in this window] [in a new window]   Figure 2. A T1-weighted black-blood spin-echo axial MRI slice (left) shows the pheochromocytoma as a bright tumor adjacent to the right atrial free wall and to the right lung. A breathhold bright-blood cine-MRI oblique slice (right) shows the tumor extending behind the superior vena cava.

The patient underwent surgical removal of the tumor and had an uneventful recovery, except for an atrial fibrillation that was resolved after a few weeks. This case emphasizes the value of pentetreotide scintigraphy to localize pheochromocytomas when MIBG scan and abdominal CT scan are negative.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cottin, Y. Articles by Wolf, J. E. Search for Related Content PubMed PubMed Citation Articles by Cottin, Y. Articles by Wolf, J. E. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Pheochromocytoma