Unsuspected pheochromocytoma incidentally found on chest CT

A 51-year-old woman with history of migraine headaches and intermittent nausea, vomiting, palpitations, and diaphoresis presented to the emergency department with hypertensive emergency 1 month after starting a beta blocker for migraine prophylaxis. Contrast-enhanced computed tomography of the chest incidentally revealed a large abdominal mass in the area of the left adrenal gland. Iodine-123 metaiodobenzylguanidine scan imaging showed localized uptake into the left adrenal gland. Along with imaging results, laboratory testing confirmed the diagnosis of pheochromocytoma. The patient was treated with blood pressure control, specifically alpha blockade, and surgical excision of the mass. This case displays a typical clinical presentation of pheochromocytoma coupled with atypical radiographic size and appearance.