Pheochromocytoma classically presents with the triad of paroxysmal headaches, palpitations and diaphoresis accompanied by hypertension. Rarely do they present with spontaneous rupture, hemorrhage and abdominal catastrophe. If unrecognized this may lead to death very rapidly. In our case 40 year male patient presented with pain in abdomen since 2 days which was sudden in onset and increasing in intensity. The patient is hypertensive and diabetic since 5 years and is on medication. On examination the patient had sweating, tachycardia, hypotension, abdominal tenderness and guarding. Computed Tomography scan revealed a large right adrenal mass with fluid collection in right peri-anterior paranerphric spaces, perimass and right para retrocolic space.
On X-ray chest a solitary pulmonary nodule in right middle zone (? metastases) was seen. Mass was operated. The histopathological examination showed features of malignant pheochromocytoma with hemorrhage and capsular destruction. We are presenting this case for its clinical, radiological and histopathological features, as malignant pheochromocytoma presenting as rupture is extremely rare.
