Hemorrhagic necrosis of a pheochromocytoma is a rare cause of acute presentation that is often devastating to patients. A 44-year-old woman with spontaneous hemorrhage into a previously undiscovered pheochromocytoma is described. The patient presented with acute cardiogenic pulmonary edema, shock, abdominal pain, myalgia and high fever. Her cardiac function recovered with aggressive medical treatment before the tumour was removed. This case illustrates an unusual presentation of pheochromocytoma and emphasizes the importance of aggressive and appropriate medical therapy in pheochromocytoma heart disease.