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case_images: Electrocardiograms. (A) Electrocardiogram obtained one month before this admission showed nearly normal. (B) Electrocardiogram at hospital admission showed QT prolongation and T-wave inversions in leads I and V1 to V6. (C) Electrocardiogram on the third hospital day showed more obvious QT prolongation and T-wave inversions in the limb leads (I, II, III, AVL, AVR and AVF) and the chest leads (V1 to V6). (D) Electrocardiogram after surgery showed QT prolongation and T-wave inversions disappeared.
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case_images: T-wave inversions in leads I and V1 to V6 ( Figures 1A, B ) . II, III, AVL, AVR and AVF) and the chest leads (V1 to V6) ( Figure 1C ). In the context of the lack of findings during CAG, the fluctuating hypertension, together with the apparent ACS and increased WBC prompted the suspicion of pheochromocytoma, which was further supported by the markedly elevated plasma normetanephrine of 2195.91 pg/mL (normal < 90 pg/mL) and plasma metanephrine of 860.22 pg/mL (normal < 180 pg/mL). His postoperative ECG showed that QT prolongation and T-wave inversions disappeared ( Figure 1D ).
case_images: Coronary angiography showed the absence of obstructive coronary lesions in RCA (A), LAD and LCX(B).
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case_images: However, CAG showed no significant stenosis ( Figures 2A, B ).
case_images: (A) Magnetic resonance imaging demonstrated a 68 x 61 mm mass in the right adrenal gland. (B) Right adrenalectomy was performed to remove a huge pheochromocytoma. (C) Pathological examination showed pheochromocytoma.
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case_images: The magnetic resonance imaging (MRI) revealed a 68 x 61 mm mass in the right adrenal gland ( Figure 3A ). He underwent successful laparoscopic right adrenalectomy, and the pathological findings confirmed adrenal pheochromocytoma ( Figures 3B, C ).