AUTHOR=Huang Wen-peng , Gao Ge , Chen Zhao , Qiu Yong-kang , Gao Jian-bo , Kang Lei 

TITLE=Multimodality Imaging Evaluation of Primary Right Atrial Paraganglioma: A Case Report and Literature Review

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.942558

DOI=10.3389/fmed.2022.942558

ISSN=2296-858X

ABSTRACT=Background：Cardiac paraganglioma (CPGL) accounts for 1% to 3% of cardiac tumors and is usually benign. 35% to 50% of CPGL secrete catecholamines, causing hypertension, excessive sweating, palpitations, headache and other symptoms. Preoperative imaging evaluation is important to determine the exact location of the cardiac mass, itsblood supply vessels, and the relationship to surrounding structures. The use of multimodal imaging techniques, combined with morphological and functional information, provides a powerful aid in the preoperative diagnosis as well as localization of CPGL, helping to reduce the incidence of intraoperative and postoperative complications and improve patient prognosis.
Case Report：A 67-year-old woman suffered with paroxysmal palpitations with a heart rate of 110 beats per minute 1 month ago. Urine catecholamine and methoxyepinephrine levels were significantly elevated. The patient had a 5-year history of hypertension with a maximum blood pressure of 160/100 mmHg. CT examination suggested a soft tissue mass in the right atrium, which showed heterogeneous significant enhancement and was supplied by the left ileal branch artery. The patient then underwent cardiac magnetic resonance (CMR). The lesion showed inhomogeneous isosignals on T1WI, slightly high signals on T2 fat-suppression image, inhomogeneous high signals on the diffusion-weighted imaging and apparent diffusion coefficient images. The mass exhibited heterogeneous and significant enhancement on the first-perfusion and delayed scans after intravenous contrast injection. However, abnormal signals were surprisingly found in the patient’s right lung, and the possibility of metastatic lesions could not be excluded, so the patient underwent PET/CT to rule out metastatic lesions. A soft tissue mass with a dense radiological distribution was seen in the right atrium, with the SUVmax at about 15.2, as well as pathological intake of brown fat in the body. The lesion showed no significant FDG uptake in PET/CT suggesting no sign of metastasis. Combined with clinical symptoms, CPGL was considered. The patient underwent surgical resection and postoperative pathology confirmed a CPGL.
Conclusion：The PET/CT imaging combined with the different image acquisition sequences of CMR in multiple directions provides a powerful aid for preoperative noninvasive diagnosis, localization, and staging of CPGL, which helps to reduce intraoperative and postoperative complications and improve patient prognosis.