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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 433-436
Pheochromocytoma : Imaging finding.

Department of Radiology-Imaging and Gastro Surgery, GB Pant Hospital New Delhi, India

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Keywords: Pheochromocytoma; CT; MR; US

How to cite this article:
Sharma A, Mishra P K, Gupta D, Singh K J. Pheochromocytoma : Imaging finding. Indian J Radiol Imaging 2005;15:433-6

How to cite this URL:
Sharma A, Mishra P K, Gupta D, Singh K J. Pheochromocytoma : Imaging finding. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Dec 3];15:433-6. Available from:

   Introduction Top

Pheochromocytoma is a rare tumor of the chromaffin cells of the adrenal medulla. It affects approximately 1 in 2,00,000 individuals in general population [1].The diagnosis is facilitated by characteristic symptoms and signs attributable to excessive release of catecholamineepinephrine and nor-epinephrine. The characteristic clinical findings include severe headaches, palpitations, excessive sweating, tremor, anxiety, and paroxysmal or sustained hypertension. Increased catecholamine in urine is diagnostic.However, when biochemical findings are equivocal a characteristic clinical picture and imaging may give us diagnosis as in our case

   A case report Top

A 24 -year -old patient presented with headaches, palpitations and accelerated hypertension for last 2 years.Urinary VMA was within normal limits US examination was performed which showed an evidence of hypoechoic lesion with few echogenic areas adjoining to the upper pole of right kidney and the lesion appeared slightly vascular on colour Doppler.[Figure - 1][Figure - 2].On plain CT ,mass lesion was hypodense (13-14 H) and was abutting the right lobe of the liver and was anterior to the the upper pole of the right kidney [Figure - 3].On CECT mass lesion has enhanced centrally and shows compression on IVC also [Figure - 4].MR was performed on 1.5T Gyroscan ACS-T. On T1W sequence there was well circumscribed hypointense lesion arising from anterior lip of the right adrenal [Figure - 5]. On T2W/SSH/60/A lesion was hyperintense, whereas on T2 SPIR D it showed small hypointense specks in hyperintense lesion [Figure - 7].On coronal SPIR D, it showed excellent orientation with relation to liver, right kidney and vertebral Body [Figure - 8].On BTFE coronal showed impression of mass on IVC [Figure - 9]. On contrast MR , there was inhomogenous enhancement of the lesion [Figure - 10].Radiological diagnosis of pheochromocytoma was suggested which was confirmed on surgery [Figure - 1].This was further confirmed on histopathology and patient have uneventful recovery.

   Discussion Top

Pheochromocytomas are extra adrenal (10%), multicentric (10%), bilateral (5%), and malignant (10%)..Size is variable from 1-20 cm.The treatment is surgical excision of tumor, which is curative in all cases. The initial imaging findings in benign and malignant pheochromocytomas are nearly identical. Only the presence of metastasis can clearly define a lesion as malignant [1].

Imaging is performed to localize a tumor that has been diagnosed biochemically.But in the present case, patient was treated medically for renal artery stenosis.Only after performing US, other radiological investigations were performed. The radiologist role is to identify whether the pheochromocytoma is from adrenal and whether it is unilateral or bilateral and to document invasion of surrounding structures and IVC. Tumors have been reported from the base of brain to the epididymis, making preoperative localization imperative. The commonest extra adrenal site is the organ of Zuckerkandle at aortic bifurcation.

On CT it appears as round or oval discrete mass with homogenous density. Similar findings have been noted in the present case. Central necrosis, calcification and cystic changes may be present in minority of cases. These vascular lesions enhance uniformly after administration of contrast material [4].The use of I/V contrast medium is controversial because it may cause a hypertensive crisis. The incidence of elevated circulating serum catecholamine with low osmolarity contrast material is generally negligible [4].CT scan of entire abdomen through aortic bifurcation are generally obtained to identify possible ectopic tumor.

MR is also excellent for evaluating intraadrenal pheochromocytoma [2].On T1, mass has intensity similar to or slightly less than solid organs. Though in present case lesion was more hypo intense as compared to adjoining organ.OnT2 lesion is hyper intense as result of their long T2 time [3].Similar intensity is noted in present case also. Sometimes adrenal metastases also present overlapping imaging findings. Combination of MIBG,CT and MRI scanning is definitive in the diagnosis of pheochromocytoma.

   References Top

1.Cirillo RL, Bennet WF.etal: Pathology of the adrenal gland: imaging features.AJR 170:429-435.1998.  Back to cited text no. 1    
2.Krebs TL, Wagner BJ: MR imaging of the adrenal gland: Radiological-Pathologic correlation.Radiographics 18:1425-1440, 1998.  Back to cited text no. 2    
3.Reining JW, Stutley JE.etal: Differentiation of adrenal masses with MR Imaging: comparison of techiniqes.Radioloy 192:41-46, 1994.   Back to cited text no. 3    
4.WelchTJ, Sheedy PFII.van Heerden JA, etal: Pheochromocytoma: Value of computed Tomography. Radiology 148: 501-503, 1983.  Back to cited text no. 4    

Correspondence Address:
A Sharma
C10 Kendriya Vihar Sector 51 NOIDA-201307
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.28766

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]


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