CARDIOVASCULAR FLASHLIGHT
Transient mid-ventricular ballooning cardiomyopathy associated with bladder pheochromocytoma
Deok-Kyu Cho1,*, Jeong Hun Kim1, and Namsik Chung2
1Division of Cardiology, Myongji Hospital, Kwandong University College of Medicine, Goyang-si, Gyeonggi-do, South Korea and 2Divisions of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
* Corresponding author. Tel: +82 31 810 6770, Fax: +82 31 810 6778, Email: chodk123@paran.com
A 45-year-old woman with no cardiac history was admitted for hematuria. A computed tomography scan revealed polypoid-enhancing mass protruding from the bladder dome to lumen (Panel A). Transurethral resectional biopsy of bladder tumourwas performed under the general anaesthesia. During the procedure, the oxygen saturation dropped, and the ECG showed sinus tachycardia with T-wave inversion in leads V2-V6. Chest X-ray showed newly developed cardiomegaly with pulmonary oedema. The troponin I level was mildly elevated. The transthoracic echocardiography revealed akinesis of the mid-ventricle with a hypercontractile apex and base. Emergency coronary angiography showed normal epicardial coronary arteries. Left ventriculography demonstrated a ballooning of midventricular segments without apical and basal involvement (Panel B). The histological finding has revealed the bladder tumour to be the pheochromocytoma. Immunohistochemical staining shows catecholamine expression on cytoplasmic granules (DAB, ×200; Panel C). Echocardiography repeated on Day 21 after surgery showed a normal left ventricular systolic function without wall motion abnormalities. On Day 32 of diagnosis, partial cystectomy was performed. The patient has not experienced any subsequent cardiac events afterwards for 5 months.
There already have been reports of Takotsubo cardiomyopathy or inverted Takotsubo cardiomyopathy associated with pheochromocytoma. However, this case is the first report of the transient mid-ventricular ballooning patterned stress-induced cardiomyopathy induced by pheochromocytoma, which developed in bladder, the extra-adrenal system.
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