BACKGROUND Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous communications between the carotid artery and cavernous sinus. They may be direct or indirect and commonly present with both ocular and neurovascular symptoms. Endovascular embolization is the main treatment, with high rates of fistula obliteration and clinical improvement. Although generally safe, complications can occur, including cranial nerve dysfunction and vascular injury. Endocrine complications following carotid-cavernous fistula embolization are exceedingly rare. To our knowledge, only 1 case of syndrome of inappropriate antidiuresis (SIAD) after Onyx embolization has been reported in the literature. CASE REPORT A 72-year-old woman developed severe symptomatic SIAD 9 days after transarterial Onyx embolization of an indirect CCF. The procedure was successful but associated with worsening of preexisting left abducens nerve paresis. She subsequently re-presented with dizziness, truncal ataxia, and confusion, which resulted in a fall involving wrist fracture but no head strike. Investigations demonstrated profound hypotonic euvolemic hyponatremia with elevated urine osmolality and urine sodium, suggestive of SIAD. The absence of hypovolemia, polyuria, and a negative fluid balance argued against cerebral salt wasting. Adrenal insufficiency, hypothyroidism, and other causes were excluded. Treatment with hypertonic saline and fluid restriction resulted in gradual sodium correction and complete neurological recovery. CONCLUSIONS Transient hypothalamic-pituitary dysfunction related to Onyx-associated local mass effect and hemodynamic changes may represent a plausible mechanism. This case highlights delayed-onset SIAD as a rare but clinically significant complication temporally associated with CCF embolization. The findings support consideration of both early and delayed electrolyte monitoring, particularly within the first 1 to 2 weeks after the procedure.

Adrenal lesions are common, occurring in approximately 5% of the population. Although the vast majority are benign, it can be challenging to differentiate clinically significant from clinically insignificant adrenal lesions given overlap in imaging features. Artificial intelligence (AI) may be able to aid radiologists in identifying adrenal masses and diagnosing their etiology. This review defines commonly used terminology in AI and summarizes AI based techniques for adrenal gland segmentation, adrenal lesion detection, and lesion characterization.

Pheochromocytoma typically presents with sustained or paroxysmal hypertension, but initial manifestation as acute non-ST-segment elevation myocardial infarction (NSTEMI) is rare. Peri-procedural hemodynamic fluctuations are often dramatic, making diagnosis and management challenging. We report a 51-year-old male admitted with chest tightness for 17 days. Elevated troponin and coronary angiography showing multivessel disease with total occlusion of the mid-left anterior descending artery (LAD) led to a preliminary diagnosis of NSTEMI. During percutaneous coronary intervention, blood pressure surged to 240/130 mmHg; intravenous nitroprusside caused an instantaneous drop to 95/55 mmHg, with rapid rebound to >200 mmHg upon withdrawal, showing no clear temporal relationship with drug administration. Postoperatively, large rapid blood pressure oscillations persisted, associated with postural changes but without patient discomfort. Workup revealed markedly elevated plasma catecholamines: dopamine 77.58 pg/mL (normal 0-20), normetanephrine 1881.63 pg/mL (0-145), and norepinephrine 5,724.04 pg/mL (217-1,109). CT and PET-CT identified a left retroperitoneal mass (59×34×44 mm, SUVmax 14.6), suggestive of pheochromocytoma. Surgical resection was performed, and histopathology with immunohistochemistry confirmed the diagnosis. Postoperatively, the patient required no antihypertensive medications and blood pressure remained stable. This case illustrates a rare pheochromocytoma presentation as secondary hypertension manifesting as acute myocardial infarction, characterized by extreme peri-procedural hemodynamic instability during PCI and an "all-or-none" response to conventional antihypertensive therapy, ultimately cured by surgical resection.

A rare case of composite pheochromocytoma (PCC) with ganglioneuroblastoma (GNB) was reported in this article, and the patient's diagnostic and treatment course-including biochemical evaluation, imaging findings, surgery, pathology, genetic testing, and postoperative follow-up-was retrospectively analyzed. Relevant literature in PubMed, Embase, CNKI, and Wanfang Data from database inception to October 1 2025 was systematically searched to identify comparable adult cases, and their clinicopathological features were summarized. The patient was a 48-year-old man who presented to the Department of Endocrinology, First Medical Center of Chinese PLA General Hospital on March 25, 2025, with hypertension for 3 months and a left adrenal mass detected 12 days earlier. Biochemical testing showed markedly elevated normetanephrine (NMN). MRI and [18]F-NOTATATE somatostatin receptor positron emission tomography-computed tomography ([18]F-NOTATATE-PET-CT) revealed a cystic-solid mass in the left adrenal gland, with increased uptake in the solid component [The maximum standardized uptake value (SUVmax) was 9.4]. Robot-assisted laparoscopic tumor resection was performed on the patient. Composite PCC, consisting of a pheochromocytoma component and a GNB component, was confirmed by postoperative pathology. No clearly pathogenic variants were detected by germline whole-exome sequencing. After surgery, blood pressure was normalized without antihypertensive medication, and no evidence of recurrence or metastasis was observed at the 6-month follow-up. The literature review identified 14 adult cases of PCC with GNB; together with the present case, 15 cases were analyzed. The age [M(Q1, Q3)] was 49 (35, 55) years. Hypertension was documented in 11 patients, elevated catecholamines or their metabolites were observed in most cases, tumors>5 cm in maximum diameter were found in 8 patients, and hereditary syndromes were identified in 3 patients. Composite PCC with GNB in adults is exceedingly rare. Its clinical, biochemical, and imaging manifestations frequently overlap with those of conventional PCC, rendering definitive diagnosis dependent on histopathological examination. Prognosis appears to be correlated with tumor components, size, and genetic syndrome status. Therefore, comprehensive postoperative pathological evaluation, germline genetic testing, and long-term surveillance are strongly recommended.

Left gastric artery aneurysms (LGAAs) are rare but potentially life-threatening vascular abnormalities often discovered incidentally during imaging for unrelated conditions. We report the case of a 54-year-old woman with a right adrenal mass in whom a partially thrombosed 2-cm LGAA was identified during preoperative evaluation. Endocrine studies confirmed a nonfunctioning adrenal adenoma. The patient successfully underwent endovascular coil embolization of the LGAA prior to her planned adrenalectomy, with only a minor access-site hematoma as a postoperative complication. This case underscores the importance of early recognition and timely intervention of visceral artery aneurysms, particularly when additional abdominal surgery is anticipated, and adds to the limited literature on diagnosis and management of LGAA.

Pheochromocytoma is a rare catecholamine-secreting tumour with diverse cardiovascular manifestations. Presentation with chest pain and troponin elevation may closely mimic acute coronary syndrome (ACS), potentially leading to diagnostic delay.

Adrenal epithelioid angiosarcoma is an exceedingly rare vascular endothelial neoplasm, accounting for a minute fraction of sarcomas with fewer than 60 cases reported in the medical literature. We report the case of a 70-year-old female with primary adrenal epithelioid angiosarcoma, presenting with a rapidly enlarging right adrenal mass and associated severe right upper quadrant pain. Biochemical testing revealed that the mass was nonfunctional, and contrast-enhanced computed tomography revealed a large, heterogeneously enhancing lesion with inferior vena cava compression. Given rapid interval growth and severe symptoms, she underwent laparoscopic adrenalectomy, and histopathology with immunohistochemistry confirmed a diagnosis of primary adrenal epithelioid angiosarcoma. Postoperative management included paclitaxel chemotherapy, and the patient has remained disease-free for 2 years post-operation. This case emphasizes that the clinical and imaging features of adrenal epithelioid angiosarcoma are nonspecific, and definitive diagnosis requires surgical pathology with vascular marker staining to avoid misclassification as metastatic carcinoma. Timely resection in combination with chemotherapy can yield favorable outcomes despite this tumor's aggressive behavior and overall poor prognosis.

BACKGROUND Cardiac paragangliomas are extremely rare neuroendocrine tumors arising from chromaffin cells of neural crest origin. These tumors are typically hypervascular and can derive part of their arterial supply from the coronary circulation. Because of their rarity and heterogeneous clinical presentation, diagnosis can be challenging. Symptoms can result from catecholamine secretion, local mass effect on adjacent cardiac structures, or incidental discovery during imaging studies. In rare cases, cardiac paragangliomas may mimic an acute coronary syndrome despite the absence of obstructive coronary artery disease. CASE REPORT A 67-year-old woman presented with non-ST-segment elevation myocardial infarction in the context of rapid atrial fibrillation. Coronary angiography demonstrated normal epicardial coronary arteries but revealed an intense vascularization of a right retroatrial mass supplied by branches of both the right and left coronary arteries. Subsequent multimodality imaging identified a well-defined hypervascular mediastinal mass highly suggestive of a cardiac paraganglioma. Elevated urinary normetanephrine levels confirmed the secretory nature of the tumor. Given the extensive vascular supply visualized on angiography, preoperative transradial transcatheter embolization of the coronary feeding vessels was performed to reduce the risk of intraoperative bleeding and possibly reduce the tumor size. The patient subsequently underwent complete surgical resection with histopathologic confirmation of cardiac paraganglioma. CONCLUSIONS This case highlights the importance of recognizing a coronary tumor blush, which should prompt comprehensive diagnostic evaluation. In this patient, preoperative embolization combined with complete surgical resection was feasible and associated with a favorable long-term outcome, and may be considered in selected cases.

Adrenal pseudocysts are rare in children and may mimic cystic adrenal tumors. We report a 6-month-old female with a left suprarenal cyst initially suspected as neuroblastoma. Surgical excision and histopathology confirmed an adrenal pseudocyst, highlighting the need to consider this entity in infants with cystic suprarenal lesions.