Abstract
A previously healthy 42-year-old man developed sudden left lower back pain when speculating in a court. An abnormality around his left kidney was pointed out in the computed tomography (CT) at a nearby hospital, and he was transferred to our hospital, where he presented with exacerbated back pain and cold sweat. His heart rate, blood pressure, and arterial lactate level were 122/min, 175/114mmHg, and 3.2mmol/L, respectively. We suspected a spontaneously ruptured pheochromocytoma. Contrast-enhanced CT revealed extravasations in the left adrenal tumor. He suddenly fell into shock, therefore, transcatheter arterial embolization (TAE) was performed to achieve hemostasis. His blood pressure fell to 70/35mmHg, but recovered to 101/50mmHg after TAE. Postoperatively, he had elevated blood pressure, tachycardia and an elevated cardiac index (4-6 L/min/m2), and he was treated with phentolamine, landiolol, and propranolol. On the 7th day after admission, he was transferred to another hospital for surgery. Left nephrectomy and adrenectomy was performed, and the tumor was pathologically diagnosed as pheochromocytoma. We experienced a rare case of ruptured pheochromocytoma treated with TAE. Iodinated contrast medium can cause adrenal crisis; however, it was not evident in this case. TAE proved to be a safe emergency hemostatic strategy for treating ruptured pheochromocytoma.
