Use of Fluorine-18-labelled Deoxyglucose Positron Emission Tomography with Computed Tomography to Localize a Paraganglioma in Pregnancy

Thomas M. Koroscil, MD, PhD; Stephen McDonald, MD; Shahan Stutes, MD; Raul J. Vila, MD

Disclosures

South Med J. 2010;103(12):1238-1242. 

In This Article

Abstract and Introduction

Abstract

A nine-weeks pregnant, 27-year-old female was admitted for hypertension with a blood pressure of 213/110 mm Hg, headaches, palpitations, and anxiety. There was no previous history of hypertension or pre-eclampsia. She had elevated urinary normetanephrine, plasma-free normetanephrine, and plasma-free metanephrine concentrations. Phenoxybenzamine and labetalol were initiated for presumed pheochromocytoma. At thirteen weeks of pregnancy, a noncontrast magnetic resonance imaging (MRI) of the abdomen failed to identify an adrenal or extra-adrenal mass. At 21-weeks gestation, an abdominal [18-F]-fluorodeoxyglucose positron emission tomography with computed tomography demonstrated an extra-adrenal lesion. The patient underwent a laparotomy during the second trimester with successful removal of a benign paraganglioma.

Introduction

Extra-adrenal pheochromocytomas are called paragangliomas. These are uncommon tumors in the general population, and extraordinarily uncommon in pregnant women. Magnetic resonance imaging (MRI) without gadolinium is the preferred imaging modality, as it minimizes any exposure to ionizing radiation. However, there are no studies available which have compared the safety and efficacy of other imaging modalities in pregnancy. We present a case where the initial MRI study was inconclusive in a pregnant patient with elevated catecholamines and classic symptoms of a pheochromocytoma. Positron emission tomography (PET) with computed tomography (CT) provided accurate localization of a paraganglioma.

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