Author + information
- Received October 10, 2012
- Accepted October 31, 2012
- Published online May 7, 2013.
A 49-year-old female presented to the department of cardiovascular surgery with short breath after activity and atypical chest discomfort during the past half a year. Physical examination, initial chest X-ray, and laboratory values were unremarkable. Computed tomography angiogram of the chest disclosed a mass (**) in middle mediastina (A and B). Transesophageal echocardiography (TEE) revealed a 6-cm heterogeneous intrapericardial mass in the left atrium (LA)–right atrium (RA)–aortic root area with plentiful blood supply by a nourishing vessel originating from the aorta (AO) (C and D, Online Videos 1 and 2). Real-time 3-dimensional TEE further delineated the tumor location in the atria–aortic root window, which was compressing the superior vena cava (SVC) (E and F). Based on the TEE findings of an encapsulated tumor without surrounding invasion, surgical excision by extracorporeal circulation was planned and performed successfully (G). Recovery was achieved over a 6-month follow-up. Microscopic examination of the tissue biopsies showed sheaths of uniform cells with abundant granular cytoplasm (40×; H&E stain) (H). Later, immunohistochemical staining of the tissue was positive for CgA and S-100 (40×) (I and J), which confirmed the diagnosis of a paraganglioma. Cardiac paraganglioma is extremely rare. Real-time 3-dimensional TEE can provide detailed information in diagnosing cardiac paraganglioma location and relation to neighbor. AOV = aortic valve; RV = right ventricle; TV = tricuspid valve.
- Received October 10, 2012.
- Accepted October 31, 2012.
- American College of Cardiology Foundation