Multimodality Imaging Appearance of Intrapericardial Paragangliomas

Figures

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  Fig. 1. Human pericardial neural plexus. The dots represent the location of the neural crest cells. The intrinsic cardiac ganglia cells are in the posterior wall of the atria, left greater, in the atrioventricular groove, and along the root of the great vessels.

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  Fig. 2. Patient 2: A 71-year-old male with an incidentally discovered mediastinal mass. Postcontrast multidetector computed tomography. ( A ) Axial image and ( B ) coronal image. A predominantly homogeneous hypervascular tumor with somewhat irregular contour occupies the anteroposterior window (arrows). The perivascular separation fat plane was preserved, and no invasion was noted. Several small serpiginous vessels are demonstrated surrounding the lesion. Note flow artifact in the superior vena cava (C), aorta (A), and pulmonary trunk (PT).

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  Fig. 3. Patient 5: A 54-year-old male with uncontrollable hypertension with intrapericardial paraganglioma. ( A ) The coronal iodine-131 meta-iodobenzylguanidine scan shows intense radiotracer uptake (white thick arrow). ( B ) Postcontrast multidetector computed tomography axial image. The large hyperenhancing tumor is in close proximity to the left atrial wall. ( C ) and ( D ) noncontrast gradient echo T1-weighted axial and sagittal images, respectively. The mass is isointense to muscle with multiple flow voids suggesting its vascular nature. ( E ) Steady-state free precession axial image demonstrates the heterogeneous signal with areas of high signal, presumed cystic degeneration, or necrosis. Infiltration at the dome of the left atrium was suspected and confirmed on surgical exploration. After a second attempt to resect residual tumor, the patient succumbed from massive hemorrhage. Aorta ( A ).

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  Fig. 4. Patient 7: Intrapericardial paraganglioma in a 63-year-old male with a history of rectal cancer. Postcontrast multidetector computed tomography: ( A ) axial image and ( B ) coronal oblique image. A heterogeneously enhancing mass is seen in the area of the aorticopulmonary window abutting the left main and proximal left anterior descending coronary arteries (black arrows in A ). Eccentric surgical clips from a previous open biopsy (arrowheads). Small arrows point at prominent serpiginous surrounding vessels. ( C ) Coronal three-dimensional maximum intensity projection fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and ( D ) fusion axial FDG-PET/CT images show the hypermetabolic nature of the tumor (arrows). Tumor (T), right ventricle (RV), left atrium (LA), left ventricle (LV).

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  Fig. 5. Patient 4: Paraganglioma in a 32-year-old male with progressive dyspnea. ( A ) Postcontrast multidetector computed tomography (MDCT) axial image. Note the large heterogeneous highly vascular middle mediastinal mass on both sides of the aortic arch. There is abutment and mild compression of the superior vena cava (arrowhead) and posterior displacement of the trachea (T). ( B ) Coronal postcontrast MDCT image. The mass (large arrows) abuts the roof of the left atrium (LA) and narrows the left mainstem bronchus (short arrows).

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  Fig. 6. ( A - B ) Hematoxylin and eosin 100x and 200x, respectively: Nested neoplastic proliferation of bland-appearing tumor cells with delicate capillary meshwork and low mitotic activity. ( C - D ) By immunohistochemistry 200x, tumor cells are positive for chromogranin and synaptophysin, respectively. Not shown, tumor cells were positive for CD56 and S100 immunostain highlighted sustentacular cells.