Intracaval extension of pheochromocytoma simulating pulmonary embolism

Pheochromocytoma, a chromaffin tumor of the sympathoadrenal nervous system, rarely exhibits direct extension into the inferior vena cava. We report a patient with a right adrenal pheochromocytoma that caused symptoms of recurrent pulmonary emboli. Intracaval extension of the tumor was detected during investigations for the source of the emboli by abdominal CT scan, ultrasonography, and venacavography. The biochemical diagnosis of pheochromocytoma was confirmed by sharply elevated catecholamine, metanephrine, and VMA urinary levels, which returned to normal upon resection of the tumor. The patient had no evidence of metastatic disease.