Author + information
- Received January 30, 2017
- Revision received February 14, 2017
- Accepted February 23, 2017
- Published online April 12, 2017.
- Rocío González-Ferreiro, MDa,∗ (, )
- Emilio Rodriguez-Ruiz, MDb,
- Diego López-Otero, MD, PhDa,
- Amparo Martínez Monzonís, MD, PhDa,
- María Álvarez Barredo, MDa,
- Ramiro Trillo-Nouche, MDa and
- José Ramón González Juanatey, MD, PhDa
- aCardiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Galicia, Spain
- bIntensive Care Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Galicia, Spain
- ↵∗Address for correspondence:
Dr. Rocío González-Ferreiro, Complexo Hospitalario Universitario de Santiago de Compostela, Cardiology Department, Rúa Choupana s/n, 15706 Santiago de Compostela, Spain.
A 58-year-old man was referred to the cardiology outpatient clinic because of palpitations. Physical examination highlighted the presence of mitral early systolic click. Transthoracic echocardiography showed a retrocardiac mass that was compressing the left atrium and surrounding the pulmonary artery and the aorta. Cardiac computed tomography demonstrated a mass extended from the upper mediastinum to the cardiac region, with invasion of the pericardium, the wall of both atria, both pulmonary arteries, and the ascending aorta (Figure 1). Histological diagnosis of paraganglioma was made by endovascular ultrasound–guided biopsy.
On coronary angiography, vascularization of the mass by coronary fistulas was demonstrated, principally dependent on the anterior descending coronary artery, intermediate branch, and right coronary artery and less importantly on the left circumflex coronary artery (Figure 2).
High vascularization and adherence to surrounding structures are characteristic of paragangliomas, making fatal hemorrhagic complications a serious risk during surgery. Pre-operative embolization has a proven role in minimizing bleeding and facilitating resection. Partial surgical excision was performed and currently is being followed up in oncology, where the patient is undergoing chemotherapy.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 30, 2017.
- Revision received February 14, 2017.
- Accepted February 23, 2017.
- 2017 American College of Cardiology Foundation