Giant paraganglioma: A successful multidisciplinary approach

Abstract

Paraganglioma of the left subclavian artery presents a unique surgical challenge, as no reports in the literature provide guidance on the optimal approach. In this case, a mini-sternotomy, combined with a multidisciplinary team of thoracic and vascular surgeons, enabled successful removal of the mass. A 62-year-old man was admitted to the hospital after an incidental discovery of a mediastinal mass during a routine check-up. Imaging revealed a 5 × 4 × 7cm fluorodeoxyglucose-avid mass originating from the prescalene portion of the left subclavian artery, with arterial supply from the inferior thyroid branch. An attempted biopsy was unsuccessful, 24-hour urinary metanephrines resulted negative, and, because the nature of the mass remained undefined, the patient was scheduled for surgical removal. The case was planned using three-dimensional reconstruction, and the mass was successfully excised via a mini-sternotomy performed by the thoracic and vascular surgery team. The final pathology report confirmed the diagnosis of paraganglioma. The left prescalene subclavian artery is an uncommon and newly described site for paraganglioma development. A mini-sternotomy provides sufficient exposure to the mass, allowing optimal control of the surrounding vessels and other critical structures. A multidisciplinary approach, involving multiple specialties, further enhances the likelihood of a successful and complication-free resection.

Keywords: Case report; Mediastinal paraganglioma; Mini-sternotomy; Paraganglioma; Subclavian artery.

Fig 1

A selective angiogram of the left subclavian artery (SA) that reveals a hypertrophic inferior thyroid artery (ITA). Other branches, including the left vertebral artery (VA) and the mammary artery (MA), were clearly visible.

Fig 2

Three-dimensional (A) and multiplanar (B) reconstruction of the mass embedded between the left common carotid artery and the left subclavian artery, elaborated from preoperative computed tomography angiography.

Fig 3

(A) J-incision mini-sternotomy showing the mass still in situ. (B) The tumor, measuring 5 × 4 × 7 cm, on the surgical table. (C) Exposure of the vascular and nerve structures after mass removal, including the subclavian artery (SA), vagus nerve (VN), innominate vein (IV), and common carotid artery (CC).