Abstract
Paragangliomas (PGs) are rare neuroendocrine tumors arising from paraganglia, clusters of neuroendocrine cells scattered throughout the body. Mediastinal paragangliomas represent less than 2% of all paragangliomas and less than 0.3 % of the mediastinal tumors. These tumors may secrete catecholamines, however in up to 50% of cases they are nonfunctional and are diagnosed incidentaly or with symptoms of mass effcet to the adjacent structures. They should be considered in the differential diagnosis of hypervascular mediastinal masses. The typical radiological features are very guiding in the diagnosis and the management of the patient. We aimed to present a case of a hypervascular middle mediastinal mass incidentally found in a 69 year old woman and diagnosed with aortopulmonary nonfunctional PG radiologically.
Highlights
Paragangliomas (PGs) are rare neuroendocrine tumors arising from paraganglia, clusters of neuroendocrine cells scattered throughout the body
Paragangliomas (PGs), sometimes called as glomus tumors, are rare neuroendocrine tumors arising from paraganglia, which are clusters of neuroendocrine cells scattered throughout the body with the largest cluster found in the adrenal medulla
While the parasympathetic PGs are generally nonsecretory and present usually with mass-effect such as cranial nerve palsies, the symphathetic paragangliomas tend to be functional and secrete catecholamines resulting in presentations with palpitations, hypertension, headaches, hyperhidrosis and diabetes which resolves after the complete resection of the PG [1,2] Symphathetic PGs can be intraadrenal which are called as pheochromocytoma or extra-adrenal which can be located in the abdomen or thorax [3]
Summary
Paragangliomas (PGs), sometimes called as glomus tumors, are rare neuroendocrine tumors arising from paraganglia, which are clusters of neuroendocrine cells scattered throughout the body with the largest cluster found in the adrenal medulla. A 69 year old female patient presented with cough, mild fever and chest pain She had recent history of Covid-19 pneumonia about 8 months ago. We performed IV contrast enhanced chest computed tomography [CT] for her presenting symptoms, which revealed a well defined middle mediastinal mass between left pulmonary artery and the descending aorta showing intermediate soft tissue density on precontrast images without any calcifications There were no symptoms suggesting increased catecholamine secretion and her 24 hour urine vanillyl mandelic acid level was within normal limits, excision of the mass was recommended rather than biopsy because of hypervascularity and close proximity of the lesion to the great vessels. Intense enhancement on early arterial phase images with multiple serpentine tortious tubular enhancing vasculature within the lesion is demonstrated (c, arrow)
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