Acute Pulmonary Edema as a Cardiovascular Manifestation of Pheochromocytoma

A case of primary pulmonary paraganglioma in a dog

Background

Lung tumors in dogs, significantly primary paragangliomas, are rare and have not been reported. This report describes a dog with a lung tumor diagnosed as a primary paraganglioma.

Case Description

A 12-year-old spayed French bulldog presented with a left-sided pulmonary mass. The dog was in good general condition and had no clinical symptoms. Computed tomography (CT) revealed a pulmonary mass near the bifurcation of the posterior lobe bronchus of the left lung. The mass showed a strong contrast enhancement effect that was subsequently attenuated. The dog underwent Surgery to remove the mass from the left lung. Abnormal hypertension was observed during surgery, and hypertensive crisis was suspected. Based on the histopathology and preoperative and postoperative urinary metanephrine and normetanephrine levels, the dog was diagnosed with primary paraganglioma of the lung. Although the CT scan showed findings suggestive of the development of a neuroendocrine tumor, it was difficult to suspect the development of a paraganglioma.

Conclusion

The possibility of catecholamine-producing tumors should be considered when we encounter a lung tumor with no clinical symptoms and a neuroendocrine tumor-like contrast enhancement pattern on a CT scan.

Successful treatment of acute respiratory failure following hypertensive crisis in a dog with presumed pheochromocytoma or paraganglioma

Background

Acute respiratory failure has been reported as one of the manifestations of hypertensive crisis in pheochromocytoma in human medicine. In dogs, no reports have been described as acute respiratory failure following hypertensive crisis. Here, we report the clinical presentation, course, and treatment of acute respiratory failure following the hypertensive crisis in a dog with presumed pheochromocytoma or paraganglioma.

Case Description

A 12-year-old neutered male toy poodle was referred for the diagnostic evaluation of a right adrenal gland mass. The dog suddenly exhibited severe dyspnea with abnormal hypertension (systolic blood pressure >200 mmHg) 15 minutes after recovery from the anesthesia for the computed tomography (CT) examination. Pulmonary CT and ultrasonography findings suggested acute onset of severe pulmonary edema. Pulmonary edema was treated with mechanical ventilation (pressure-support ventilation with continuous positive airway pressure) and negative fluid balance after the administration of furosemide. Weaning from mechanical ventilation was successful 24 hours after the onset of respiratory failure. Finally, the dog was discharged 3 days after weaning from ventilation without complications.

Conclusion

This report outlines a case of acute respiratory failure following a hypertensive crisis requiring mechanical ventilatory management in a dog. The onset and progression of pulmonary edema were extremely rapid. However, improvement in pulmonary edema was also rapid. Hemodynamic stability, in addition to prompt diagnosis and aggressive therapeutic intervention, including mechanical ventilation, may have contributed to the good prognosis of pulmonary edema following hypertensive crisis in a dog, which we attribute to a catecholamine storm.