Primary cardiac paraganglioma with intratumoral coronary artery aneurysm

Intratumoral pseudoaneurysm in a carotid body tumor

Background

The occurrence of secondary vascular pathology in paragangliomas is extremely rare, particularly in carotid body tumors (CBTs).

Case Description

A 73-year-old female presented with computed tomography angiography revealing a right CBT with a large intratumoral contrast collection. Digital subtraction angiography confirmed a CBT with an internal carotid artery (ICA) intratumoral pseudoaneurysm. Interventional neuroradiology performed coil embolization of the pseudoaneurysm, and a covered stent was placed in the ICA. Surgical intervention was deferred, and the patient was closely monitored with Doppler ultrasound.

Conclusion

Diagnostic imaging is crucial in the management of CBT, offering detailed assessment of tumor morphology and their anatomical relationships, particularly in identifying coexisting vascular anomalies. Recognition of vascular pathologies, such as intratumoral pseudoaneurysms, is critical, as failure to do so could lead to life-threatening complications, including severe bleeding during surgical resection. In cases where surgical resection is high risk due to tumor classification or patient comorbidities, palliative endovascular treatment presents a viable alternative. This approach not only reduces tumor vascularity and provides symptomatic relief but also minimizes procedural risks. While surgical resection remains the gold standard for complete tumor removal, embolization serves as an option in complex or inoperable cases and may also be used to reduce intraoperative risks when surgery is feasible.

Multimodality Imaging of Benign Primary Cardiac Tumor

Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.