Author + information
- Received July 17, 2009
- Revision received September 28, 2009
- Accepted September 28, 2009
- Published online June 1, 2010.
A 28-year-old man presented with paroxysmal hypertension (161/114 mm Hg) and tachycardia (131 beats/min). Urinary noradrenaline was 4,892 nmol/24 h (normal <498), and serum chromogranine A was 210 μg/l (normal 19.4 to 98.1 μg/l). A metaiodobenzylguanidine scintigraphy and a computed tomography (CT) scan with single-photon emission-CT fusion revealed 2 high mediastinal uptakes and 1 retroperitoneal uptake respecting adrenal glands (A). A 64-multidetector gated CT demonstrated 2 highly vascularized cardiac tumors (B to F, Online Video 1): 1 anterior, lying above the left anterior descending coronary artery (LAD) (white arrows); 1 posterior, above the left atrium (black arrows). The feeding vessels for the anterior tumor originated from the LAD and from a small branch of the right coronary artery (white arrowheads). The feeding vessel for the posterior tumor was a branch of the circumflex artery (black arrowheads). Coronary angiography confirmed the triple origin of the feeding vessels (G, Online Video 2). The tumors could be completely resected with a LAD bypass graft. Histopathologic examination (images not available) confirmed paragangliomas. Genetic testing showed deletion of succinate dehydrogenase subunit D.
- Received July 17, 2009.
- Revision received September 28, 2009.
- Accepted September 28, 2009.
- American College of Cardiology Foundation