Increased Neutrophils in Bronchoalveolar Lavage Fluids from a Patient with Pulmonary Edema Associated with Pheochromocytoma

Abstract

Pulmonary edema, both cardiogenic and noncardiogenic, has been reported as a manifestation of pheochromocytoma. We report a patient with pheochromocytoma complicated by acute pulmonary edema that appeared clinically noncardiogenic. The patient had an uncomplicated course and rapid resolution of pulmonary edema. Bronchoalveolar lavage fluids (BALF) showed a marked accumulation of neutrophils, suggesting involvement of neutrophil-mediated lung injury in noncardiogenic pulmonary edema associated with a pheochromocytoma.

Pulmonary Edema in Pheochromocytoma

“…Sukoh et al reported a case with noncardiogenic pulmonary edema associated with pheochromocytoma, and found neutrophil accumulation in the lung in this case (11).…”

Takotsubo-like cardiomyopathy in pheochromocytoma

“…Although majority of pheochromocytomas mainly secrete norepinephrine, predominantly epinephrine secreting pheochromocytomas may present with hypotension and shock due to an interplay of multiple factors, including intravascular volume depletion, abrupt cessation of catecholamine secretion due to tumor necrosis, desensitization of adrenergic receptors and hypocalcemia [57,58]. Pheochromocytoma can also cause non-cardiogenic pulmonary edema due to increased hydrostatic pressure through overfilling or constriction of the efferent pulmonary veins and endothelial injury mediated increased pulmonary capillary permeability [59]. These pathophysiological processes may also explain the greater incidence of complications in the overall cohort of TTC-pheo patients as compared to TTC-p patients.…”

Emergencies Caused by Pheochromocytoma, Neuroblastoma, or Ganglioneuroma

“…Infrequently, pulmonary edema is the presenting feature of pheochromocytoma [31,[83][84][85]. This event has even been documented following surgery for an unrelated illness [86].…”

“…Recently, it has been suggested that increased pulmonary neutrophil accumulation caused by catecholamine excess may have a pathophysiologic role in the development of pulmonary edema. Neutrophil-mediated injury would, in turn, lead to increased vascular protein permeability and promote lung edema [85].…”