MIBG-SPECT/CT-angiography with 3-D reconstruction of an extra-adrenal phaeochromocytoma with dissection of an aortic aneurysm

Excerpt

Phaeochromocytomas can cause severe complications like stroke, lung oedema, myocardial infarction or aortic dissection. Ten percent of phaeochromocytomas originate in extra-adrenal localisations and can be detected with ¹²³I-MIBG scintigraphy [1]. We report on a 50-year-old patient with weight loss, night sweating and increased urinary noradrenaline levels. SPECT with 358 MBq ¹²³I-MIBG and additionally a dual-phase diagnostic CT were performed, showing increased MIBG uptake para-aortally on the left side (a,b, arrow) corresponding to a hypervascularised lesion visible on CT (b, arrow) [2]. Additionally, in CT a thoracic aneurysm with type B aortic dissection (a,b, arrowheads) was detected. For surgical planning, CT-angiography and SPECT were combined in a fused 3D rendering using the PMOD 2.75 software (see figure). The paraganglioma was resected and 1 month later the aneurysm was successfully treated with a stent graft. There are some case reports in the literature about phaeochromocytomas associated with aortic or carotid dissections [3‐5]. SPECT/CT-angiography with fused 3D reconstruction requires appropriate software and some postprocessing time but provides the surgeon with important functional and morphological information for adequate therapy planning. ¹⁸F-DOPA PET/CT could be another interesting tool for imaging of such patients [6]. …