A Rare Cardiac Neoplasm Presenting as a Chest Pain

Cardiac paragangliomas are the rarest primary cardiac tumours and account for less than one percent of cases. A 24-year-old man presented with complaints of sudden onset of chest pain. The pain started suddenly when he was skiing halfway down the slope and went into a tuck position. Physical examination was significant for elevated jugular venous distension. His electrocardiogram revealed diffuse ST elevation suggestive of acute pericarditis. The echocardiogram revealed pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis, but the effusion rapidly re-accumulated, requiring a second pericardiocentesis. Computed tomography scan of the chest revealed haemorrhage in the anterior left mediastinum with pericardial extension. The patient underwent emergency cardiac surgery. A 5.0 x 4.5 x 3.2 cm mass, diagnosed histopathologically as paraganglioma, was excised without complication. In all cardiac or extra cardiac tumours we should check pre-operatively for hormonal activity and pre-operative and intra-operative adrenergic blockade must be employed in all secretory paragangliomas.