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Punzo B, Baldi D, Ranieri B, Cavaliere C, Cademartiri F. Multimodality imaging of a cardiac paraganglioma: A case report. Front Cardiovasc Med 2023; 10:1123789. [PMID: 37034328 PMCID: PMC10080151 DOI: 10.3389/fcvm.2023.1123789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Cardiac paragangliomas (PGLs) are rare extra-adrenal tumors that arise from chromaffin cells of the sympathetic ganglia. PGLs are often diagnosed incidentally, in the absence of symptoms, or with symptoms related to cardiovascular dysfunction. Cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can be used to accurately determine the lesion morphology and position as well as providing detailed tissue characterization. A multimodal imaging approach, not yet standardized, could be useful either in diagnosis and monitoring or in treatment planning. In the case reported here, CCT and CMR were performed to define lesion anatomy, and a reconstruction was generated using cinematic rendering (CR) to characterize the PGL angioarchitecture.
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Affiliation(s)
- Bruna Punzo
- IRCCS SYNLAB SDN, Naples, Italy
- Correspondence: Bruna Punzo
| | | | | | | | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio/CNR, Pisa, Italy
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Bansal N, Walters HL, Aggarwal S. Cardiac Paraganglioma in a 14-Year-Old. World J Pediatr Congenit Heart Surg 2019; 12:433-436. [PMID: 31088210 DOI: 10.1177/2150135118824077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac paraganglioma (PGL) is a rare catecholamine-secreting tumor forming 1% to 3% of cardiac tumors. Although most PGL occur sporadically, evidence exists that 40% of them may be related to familial cancer predisposition syndromes. We present a unique case of a 14-year-old female who presented with persistent hypertension and was found to have a cardiac PGL. During surgical resection, even though the main right coronary was preserved, the sinoatrial (SA) nodal artery was surrounded by the tumor and required resection with the tumor. The patient subsequently developed SA node dysfunction and is currently being evaluated for placement of a permanent pacemaker.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, 2969Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Henry L Walters
- Division of Cardiothoracic Surgery, 2969Children's Hospital of Michigan, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Division of Cardiology, 2969Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Gupta PN, Sagar N, Ramachandran R, Rajeshekharan VR. How does knowledge of the blood supply to an intracardiac tumour help? BMJ Case Rep 2019; 12:12/2/e225900. [PMID: 30804157 DOI: 10.1136/bcr-2018-225900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
| | - Nishant Sagar
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
| | - Ritesh Ramachandran
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
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Arcos L, Bustos J, Acuña J, Cely A, Forero J, Jaimes C. Cardiac Paraganglioma: Advantages of Cardiovascular Multimodality Imaging. CASE (PHILADELPHIA, PA.) 2018; 2:266-272. [PMID: 30582088 PMCID: PMC6302035 DOI: 10.1016/j.case.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac paragangliomas are infrequent tumors. The most common location is in the left atrium. Cardiovascular morbidity and mortality without treatment are high. Different imaging techniques help determine the relation with adjacent structures. Multimodal cardiovascular imaging is an essential tool for diagnosis and therapy.
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Affiliation(s)
- Laura Arcos
- Universidad del Rosario Escuela de Medicina y Ciencias de la Salud, Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Jorge Bustos
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | | | | | - Julián Forero
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Claudia Jaimes
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
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Gomes TA, Mendes TM, Gaiotto FA, Gutierrez PS. Paraganglioma in an explanted heart. Cardiovasc Pathol 2018; 34:40-42. [PMID: 29567585 DOI: 10.1016/j.carpath.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022] Open
Affiliation(s)
- Thayssa Araújo Gomes
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Marques Mendes
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Antônio Gaiotto
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Sampaio Gutierrez
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Spencer D, Evans M, Wang B, Delrosario JL, Cheng T, Milliken J. Unusual cardiac paraganglioma mimicking an atypical carcinoid tumor of the lung. J Thorac Dis 2018; 10:E31-E37. [PMID: 29600100 DOI: 10.21037/jtd.2017.11.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a case of unusual cardiac paraganglioma (PG) initially misdiagnosed as atypical carcinoid tumor of the lung and discuss key clinical and pathologic characteristics that guide surgical management of these rare chromaffin cell tumors. A 64-year-old female with persistent cough and back pain was found to have a 4 cm × 3 cm mass abutting multiple cardiopulmonary structures. A biopsy was performed at an outside institution and pathology reported "atypical neuroendocrine carcinoma, consistent with carcinoid". The patient was transferred to our institution and pericardial resection with right pneumonectomy was performed to excise the tumor. Histology of the mass was that of PG with multiple ethanol embolizations. Immunohistochemical examination revealed that type I (chief) cells were positive for neuroendocrine markers (chromogranin A and synaptophysin), while type II (sustentacular) cells were positive for S100. There was no evidence of atypical carcinoid tumor in the lung. PG is an entity of chromaffin cell tumors that often affects the adrenal glands and carotid body. PG rarely occurs in the thoracic region, accounting for just 1-2% of all PG. Proper diagnosis of cardiac PG is challenging owing to its rare prevalence, subtle symptoms of presentation, and the neuroendocrine histopathological features it shares with atypical carcinoids. These tumors are typically benign and are best treated by surgical resection. Our report examines the approach to appropriate diagnosis of cardiac PG vs. atypical carcinoid, preoperative management, and surgical treatment by describing successful resection through thoracotomy without the use of cardiopulmonary bypass.
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Affiliation(s)
- Dean Spencer
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Mark Evans
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - Beverly Wang
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - J Lawrence Delrosario
- Department of Surgery, Division of Cardiothoracic Surgery, University of California Irvine, Irvine, CA, USA
| | - Timmy Cheng
- Department of Medicine, Division of Pulmonology and Critical Care, University of California Irvine, Irvine, CA, USA
| | - Jeffrey Milliken
- Department of Surgery, Division of Cardiothoracic Surgery, University of California Irvine, Irvine, CA, USA
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Ocazionez D, Shroff GS, Vargas D, Dicks D, Chaturvedi A, Nachiappan AC, Murillo H, Baxi A, Restrepo CS. Imaging of Intrathoracic Paragangliomas. Semin Ultrasound CT MR 2017; 38:584-593. [PMID: 29179898 DOI: 10.1053/j.sult.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intrathoracic paragangliomas are uncommon and only represent 1%-2% of paragangliomas. They are most commonly found in mediastinal compartments (aortopulmonary window or posterior mediastinum). Computed tomography, magnetic resonance, and specific nuclear medicine radiotracers are routinely used to characterize these lesions and help exclude other more common conditions. Selective angiography is currently used for preoperative embolization and mapping of the vascular supply before surgical resection, rather than for diagnostic purposes alone.
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Affiliation(s)
- Daniel Ocazionez
- Department of Diagnostic and Interventional Imaging, The University of Texas Medical School at Houston, Houston, TX.
| | - Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Demetrius Dicks
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT
| | | | - Arun C Nachiappan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Ameya Baxi
- Department of Diagnostic Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Carlos S Restrepo
- Department of Diagnostic Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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