Extract

A 48-year-old woman was referred to the cardiology division under suspicion of cardiac metastasis of melanoma. She had previously been diagnosed with orbital melanoma, and her right eye had been enucleated 1 year prior to her referral. Although there was no other metastatic lesion, a round-shaped mass with intense FDG uptake was found beside the right heart on positron emission tomography–computed tomography (PET–CT; Panels A and B). Echocardiography revealed a round-shaped mass at the right atrioventricular groove (Panel C, see Supplementary data online, Video S1). Cardiac magnetic resonance confirmed a well-demarcated, round mass with a size of 2.8 cm along the right atrioventricular groove. This mass showed intermediate signal intensity on both T1- and T2-weighted images without any delayed enhancement or fat suppression (Panels D and E). Due to her complaints of palpitation and paroxysmal elevations in blood pressure found in careful history-taking, a 24-h urine study was conducted and significant overproduction of catecholamine was proved. Preoperative coronary angiography revealed a hypervascular cardiac mass supplied by multiple feeding vessels from the right coronary artery (Panel F, see Supplementary data online, Video S2). After a 2-week pretreatment with alpha- and beta-blockers, the mass was excised with meticulous ligation of the feeding vessels (Panel G). A histological examination revealed findings that were all compatible with pheochromocytoma (Panel H).

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