CTICasesReverse Takotsubo Cardiomyopathy Secondary to Paraganglioma
Imaging findings
A chest radiograph shows a left paratracheal mass. CT reveals an avidly enhancing paravertebral mass remodeling the vertebral body. MRI cine images demonstrate severe hypokinesis/akinesis of the mid-ventricle and base, with preserved apical motion, characteristic of reverse takotsubo cardiomyopathy. Late gadolinium enhancement (LGE) MRI shows no abnormal LGE, ruling out ischemic cardiomyopathy. A MIBG scan shows uptake in the mass. Laboratory values confirm dramatically elevated normetanephrines.
Key takeaways
Reverse takotsubo cardiomyopathy (basal and mid-ventricular hypokinesis with preserved apical motion) can be caused by catecholamine surges. A paravertebral mass with avid enhancement and elevated catecholamine levels should strongly suggest a paraganglioma. The distribution of beta-receptors in the heart, which differs between younger and older patients, may explain the reverse pattern in younger individuals compared to the typical apical ballooning seen in older patients with stress-induced cardiomyopathy.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Iatrogenic RV Perforation with Hemopericardium from Retained Thrombolysis CatheterIatrogenic
- Acquired Ventricular Septal Defect (VSD) with Possible Pericardial Rupture Post-MIVascular
- Coarctation of the Aorta with Classic '3 Sign'Congenital
- Spinal HemangioblastomaNeoplastic
- Short Telomere Syndrome with UIP Pattern, Cirrhosis, Splenomegaly, and Hepatopulmonary SyndromeILD
- Intrathoracic Gastric Herniation with Pseudo-Pneumothorax Post-Hiatal Hernia RepairOther
- Pulmonic Valvular Stenosis with Post-Stenotic Dilation of the Main and Left Pulmonary ArteriesCongenital
- Anomalous Left Superior Pulmonary Vein Drainage (Variant Anatomy)Congenital
See all cases from September 30, 2016 →
Related Neoplastic cases
- Left Atrial Myxoma with Variable Appearance on MRI
- Thymic Carcinoma with Initial Regression and Subsequent Recurrence/Growth
- Malignant Fibrous Tumor of the Pleura (Mediastinal Origin)
- Right Atrial Myxoma with Pulmonary Embolism and Hemorrhage
- Adenocarcinoma in the Context of Fibrosing Lung Disorder
- Hyaline Vascular Castleman Disease (Internal Mammary Lymph Node)