Phéochromocytome révélé par une dissection coronaire spontanée : à propos d'un cas inhabituel

Abstract

Background

Spontaneous coronary artery dissection (SCAD) is a rare and under-diagnosed disease that accounts for 1 to 4% of acute coronary syndromes and nearly one-third of heart attacks in women under the age of 50. We present a unique case of a pheochromocytoma that contributed to SCAD.

Case summary

A 49-year-old patient presented to the emergency department with chest pain that had been evolving for several days. The diagnosis was a late ST ST-segment elevation Myocardial Infarction (STEMI) in the anterior leads. Echocardiography has shown a severe left ventricular dysfunction related to a large akinesis of anterior and lateral segments. Coronary angiography revealed a recent occlusion due to spontaneous dissection of the mid left anterior descending artery and of the first and second obtuse marginal arteries. During the same hospitalization, incidental findings from a CT pulmonary angiography led to the discovery of a left adrenal mass. Subsequent abdominal scanning and blood/urine assays confirmed a diagnosis of pheochromocytoma. The patient underwent follow-up coronary angiography and cardiac MRI to evaluate cardiac involvement before undergoing surgical removal of the pheochromocytoma.

The patient has undergone successful surgical ablation two months after STEMI in a referral center for endocrinology surgery with an optimal cardiological technical platform.

Discussion

Spontaneous coronary artery dissection is a rare and potentially fatal disease and has never been described in the literature in association with a pheochromocytoma. Similar cases require a multidisciplinary approach, as well as surgery carried out in a facility equipped with advanced cardiac techniques. Given the curative potential of pheochromocytoma, early detection of SCAD is essential to reduce the risk of recurrence.