Rare Case of Urinary Bladder Pheochromocytoma Mimicking Heart Attack Successfully Treated at Fortis Hospital Mulund
Rare Case of Urinary Bladder Pheochromocytoma Mimicking Heart Attack Successfully Treated at Fortis Hospital Mulund
In a rare and challenging case, a 71-year-old Mumbai-based woman who initially presented with symptoms of a heart attack was ultimately diagnosed and successfully treated for an extremely rare tumor of the urinary bladder—Pheochromocytoma, also known as Paraganglioma. Pheochromocytomas, in the urinary bladder are extremely rare, accounting for approximately 0.05–0.1% of all bladder tumors and less than 1% of all pheochromocytomas. These tumors are known to cause dangerous spikes in blood pressure and are often termed “the great masquerader” due to their vague symptoms.
It all started when the patient initially was rushed to the hospital with complaints of chest pain and breathlessness and was diagnosed with a Myocardial Infarction. However, Coronary Angiography revealed normal arteries. She was discharged after medical management with blood thinners and cholesterol-lowering drugs. Over time, her symptoms worsened. On follow-up, doctors noted a history of uncontrolled Hypertension and episodic palpitations, sweating, anxiety, tremors, and racing heartbeat—classic but often overlooked signs of Pheochromocytoma.
A mass in her bladder, previously detected but not investigated further, prompted suspicion. Blood tests revealed elevated Catecholamines, and imaging confirmed the diagnosis of urinary bladder Pheochromocytoma. To further complicate matters, it was also found she had about 80% Coronary Artery blockage which complicated the treatment plan as it raised a dilemma for the doctors who pondered on whether to address the heart condition first or remove the hormone-secreting tumor, which itself could trigger cardiac complications.
The multidisciplinary team led by Dr Sweta Budyal, Consultant-Endocrinology & Diabetology, Dr Saurabh Patil, Senior Consultant-Urology, and Dr Anil Daxini, Consultant-Physician along with a team of Internal Medicine Specialists & Anesthesiologists had a decision to make whether to address the heart issue or remove the tumor which could cause further cardiac issues. Upon multiple rounds of discussions and consideration of all points it was decided that the patient will go through the tumor removal first. This was decided as treating the heart disease first meant that the patient will have to be on blood thinners post revascularization, which will increase the risk of bleeding during the tumor removal.
Doing surgery first entailed risks of (cardiovascular compromise in form of accelerated Hypertension, Heart Failure, Heart Attack, spam of blood vessels) during or post-surgery. Her Coronary Angiography conducted three ago was normal. Her recent CT Coronary Angiography pre-operatively showed 80% blockage in main coronary artery. Pheochromocytomas are like chemical bombs releasing huge quantities of vasoactive chemicals with or without a precipitating factor like surgery. Surgeons went ahead with removing tumor first because presently the patient was more symptomatic from the Pheochromocytoma rather than her heart disease. Meticulous planning and infrastructural backing, the surgeons went in for the surgery. Post-operative Ischemic Heart disease risk is more of a demand supply mismatch, and clinical team was confident of negotiating the challenges in the preoperative period.
This case underscores the importance of a high index of clinical suspicion, timely investigation, preoperative preparation, and a collaborative, team-based approach in managing rare but potentially life-
threatening conditions. Early diagnosis and targeted intervention were also key to this patient’s recovery. The patient is now on maintenance medication for her cardiac concerns, and will be scheduled for intervention in the coming months.
Keep track of your appointments, get updates & more!
