Right Thoracoabdominal Approach for Retrocardiac Paraganglioma Resection

Abstract

Paragangliomas are rare extra-adrenal tumors of sympathetic or parasympathetic paraganglia origin; of these, mediastinal paragangliomas are 2% of all cases. We present the case of a 21-year-old woman with uncontrolled arterial hypertension who had a functioning 6.5 × 6.2-cm retrocardiac paraganglioma firmly attached to the pericardium. The patient underwent tumor resection via a right thoracoabdominal incision; this surgical approach enabled adequate exposure for complete resection without institution of cardiopulmonary bypass or need for cardiac reconstruction or autotransplantation. Ten months postoperatively, the patient was doing well and was no longer hypertensive.

Keywords: Cardiac surgical procedures/methods; diagnostic imaging; heart neoplasms/surgery; hypertension/etiology; mediastinal neoplasms/diagnosis; paraganglioma, extra-adrenal/pathology/radiography/surgery; treatment outcome; vascular neoplasms/surgery.

Fig. 1.

A) Fluorine-18-L-dihydroxyphenylalanine positron emission tomogram–computed tomogram shows a retrocardiac paraganglioma (arrow). B) Chest computed tomogram confirms a 6.5 × 6.2-cm vascularized mass in the posterior mediastinum.

Fig. 2.

Intraoperative photographs. A) The deflated right lung was mobilized laterally, and a plane was found between the tumor and the surrounding structures, enabling circumferential dissection of the mass via a limited pericardiectomy. B) The mass was successfully removed without major intraoperative bleeding. PA = pulmonary artery; PN = phrenic nerve; PV = pulmonary vein

Fig. 3.

A) Macroscopically, the resected tumor was well-demarcated, highly vascular, and removed with free margins. B) Cytologic examination revealed the Zellballen pattern of paraganglioma (H & E, orig. ×40).