Quiz Case 4 page 2

Fig 2
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There is no cardiac uptake. This is typical of a denervated heart, which is necessarily the case in an orthotopic cardiac transplant. Fig 2 shows the abdominal SPECT of the same study with a hot spot in the right adrenal, and fig 3 is the CT. Diagnosis - phaeochromoctoma

Fig 3
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It was not appreciated before transplant that this man had hypertensive heart failure: falling LV function had dropped the systolic blood pressure. Phaeochromocytoma should be considered in any patient in severe heart failure with a systolic blood pressure over 100mmHg.