• Xinsheng Xi, Guanghui Yan, Baihong Guo, Gang Jin, Chenming Guo, and Bin Feng.
• Department of Urology, Gansu Provincial Hospital, Lanzhou, China.
• Medicine (Baltimore). 2024 Dec 13; 103 (50): e40939e40939.

RationalePheochromocytomas typically arise in the adrenal medulla, whereas ectopic pheochromocytomas/paragangliomas commonly occur near the abdominal aorta, bladder, mediastinum, and head. Diaphragmatic pheochromocytomas are exceedingly rare, and there is limited surgical experience with their treatment.Patient ConcernsIn Case A, the subject is a 45-year-old male, while in Case B, the subject is a 59-year-old female. Both patients present with a history of paroxysmal hypertension. Computed tomography imaging revealed the presence of diaphragmatic tumors in both patients. The tumor in Case A was observed in the left diaphragm, while the tumor in Case B was located in the right diaphragm.DiagnosesTwo patients were diagnosed with diaphragmatic pheochromocytoma on the basis of disease progression, imaging, endocrinological assessment and postoperative histopathological examination.InterventionBoth patients received the same standardized preoperative preparation, which included hypotensive therapy and intravenous rehydration. Subsequently, Case A underwent a transabdominal robotic laparoscopic surgical resection, while Case B underwent a transthoracic thoracoscopic surgical resection.OutcomesBoth patients demonstrated a favorable recovery trajectory and exhibited stable blood pressure at the 3-month follow-up.LessonsThis report serves to remind the reader that the transthoracic approach to diaphragmatic pheochromocytoma may prove to be more advantageous than the transperitoneal approach. Additionally, precise preoperative localization of the tumor and careful intraoperative monitoring and assessment are imperative to achieve favorable outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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