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患者女,45岁.因发作性心慌、胸闷伴头痛、出汗1天于1992年7月12日入院.查体:体温38.4℃,脉搏122次/分,血压测不到.躁动不安,面色苍白,四肢发凉.两肺无罗音.心率122次/分,律整,心音低钝,无杂音.腹部无异常.心电图示Ⅰ、Ⅱ、aVF、V3～V6导联ST段平直下移0.1mV以上,T波倒置,aVR导联ST段抬高,T波直立.拟诊为急性心内膜下心肌梗塞、心源性休克.未予升压药物治疗于20分钟后血压为37/20kPa,之后血压反复波动于34～8/18～6kPa之间.血清肌酸磷酸肌酶、谷一草转氨酶、乳酸脱氢酶均高于正常两倍以上.血压上升时尿香草基苦杏仁酸定性阳性.B超示左肾上方有一囊实混合性包块,CT示左肾上腺区见一不规则形块影.于1992年8月21日手术切除,肿瘤大小15×10×10cm,重517.3g.病理报告为左肾上腺嗜铬细胞瘤.
The patient, 45 years old, was admitted to hospital on July 12, 1992 for paroxysmal palsy, chest tightness, headache, and sweating. Physical examination: body temperature 38.4°C, pulse rate 122 beats/minute, undetectable blood pressure, restlessness, complexion Pale, cold limbs. No lungs in both lungs. Heart rate 122 beats per minute, regularity, low sound blunt, no noise. No abdomen abnormalities. ECG diagrams I, II, aVF, V3 ~ V6 lead ST segment down 0.1 More than mV, T-wave inversion, ST-segment elevation in lead aVR, T-wave upright. Intended to be diagnosed as acute subendocardial myocardial infarction, cardiogenic shock, and without prescribing drug therapy, blood pressure is 37/20 kPa after 20 minutes. , After repeated fluctuations in blood pressure between 34 ~ 8/18 ~ 6kPa. Serum creatine phosphate muscle enzymes, glutamic-oxalacetic transaminase, lactate dehydrogenase were more than twice normal. Blood pressure rise when urinary vanillin - amytharidin qualitative positive The B ultrasound showed a cystic solid mixed mass on the left kidney, and CT showed an irregular block shadow in the left adrenal gland area. On August 21, 1992, the tumor was resected with a tumor size of 15×10×10 cm and a weight of 517.3 g. The pathology report was left adrenal pheochromocytoma.