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Lorca MC, Chen I, Jew G, Furlani AC, Puri S, Haramati LB, Chaturvedi A, Velez MJ, Chaturvedi A. Radiologic-Pathologic Correlation of Cardiac Tumors: Updated 2021 WHO Tumor Classification. Radiographics 2024; 44:e230126. [PMID: 38722782 DOI: 10.1148/rg.230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Maria Clara Lorca
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Irene Chen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Gregory Jew
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Andrea C Furlani
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Savita Puri
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Linda B Haramati
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Moises J Velez
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
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AlRasheed MM. Genetics of Cardiac Tumours: A Narrative Review. Heart Lung Circ 2024; 33:639-647. [PMID: 38161083 DOI: 10.1016/j.hlc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
Cardiac tumours can occur in association with genetic syndromes. Rhabdomyomas have been reported in association with tuberous sclerosis, myxomas with Carney's complex, cardiac fibromas with Gorlin syndrome, and paragangliomas with multiple endocrine neoplasm syndrome. The presentation and prognosis of cardiac tumours associated with genetic syndromes differ compared with sporadic cases. Knowledge about the associated syndromes' genetic features and extracardiac manifestations is essential for the diagnosis, prognosis, and management of cardiac neoplasms. Moreover, identifying genetic mutations in benign and malignant cardiac tumours is needed to personalise management and improve treatment outcomes. Thus, this review discusses the genetic abnormalities associated with cardiac tumours, the current genetic screening recommendations, and the effect of those genetic mutations on the outcomes.
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Affiliation(s)
- Maha M AlRasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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3
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Bernal Torres W, Vinasco LAG, Gómez JE, de León JDLP. Cardiac paraganglioma: implications and impacts of a rare disease-a case report †. Eur Heart J Case Rep 2024; 8:ytae032. [PMID: 38496798 PMCID: PMC10941256 DOI: 10.1093/ehjcr/ytae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 03/19/2024]
Abstract
Background Tumour-producing catecholamines arise in the adrenal medulla (pheochromocytomas), as well as in extra-adrenal chromaffin cells (paragangliomas). The origin can be from any location; however, it is very rare in the heart. Case summary A 43-year-old woman with a history of arterial hypertension presented with dyspnoea on moderate exertion, New York Class Association (NYHA) functional classes III and IV, and oedema in the lower extremities. Medical and laboratory evaluation revealed an NT-proBNP of 6046 pg/mL, a left ventricular ejection fraction (LVEF) of 15%, longitudinal strain of -7%, and a mass located on the inner surface of the left atrioventricular groove. Surgical intervention was performed, and the tumour was resected. Pathological report showed an extra-adrenal paraganglioma without neoplastic involvement in the margins of the vena cava. After surgery, the patient showed clinical improvement with NYHA functional class I, LVEF of 56%, and longitudinal strain of -20% on transthoracic echocardiography 4 months after treatment. Discussion Paragangliomas are tumours that are rarely found in the heart, and their diagnosis is difficult. However, early detection and treatment can improve the quality of life of affected patients.
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Affiliation(s)
- Wikler Bernal Torres
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
| | - Leidy A Giraldo Vinasco
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | - Juan Esteban Gómez
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
| | - Juan D López Ponce de León
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
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Lin D, Cavalcante J, Cheng V, Lesser J. Exertional Angina in a Young Woman Caused by Large Cardiac Paraganglioma. JACC Case Rep 2024; 29:102209. [PMID: 38379646 PMCID: PMC10874983 DOI: 10.1016/j.jaccas.2023.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
Coronary ischemia is uncommon in patients in their third decade of life. We present a 21-year-old woman with classic exertional angina secondary to a large cardiac paraganglioma. Cardiac paragangliomas are rare extra-adrenal neuroendocrine tumors that arise from chromaffin cells. Cardiac symptoms can be related to catecholamine excess or anatomical compression.
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Affiliation(s)
- David Lin
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - Joao Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - Victor Cheng
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - John Lesser
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
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Kharbanda RK, Vos RJ, Morreau H, Braun J. Surgical Resection of Cardiac Paragangliomas Surrounding Both Coronary Arteries. CJC Open 2024; 6:59-61. [PMID: 38313346 PMCID: PMC10837720 DOI: 10.1016/j.cjco.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/08/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Rohit K Kharbanda
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Roemer J Vos
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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de Brito Marques F, Simões de Carvalho F, Marques AP. An incidental intrapericardial paraganglioma followed up for 11 years. ANNALES D'ENDOCRINOLOGIE 2023:S0003-4266(23)00742-4. [PMID: 38040088 DOI: 10.1016/j.ando.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francisca de Brito Marques
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Matosinhos, Portugal.
| | - Francisco Simões de Carvalho
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Matosinhos, Portugal
| | - Ana Paula Marques
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Matosinhos, Portugal
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Wang D, Gu C, Lv M, Wang Y. Roxadustat reduced the risk of perioperative complication arising from the treatment of cardiac paraganglioma: A case report. Asian J Surg 2023; 46:3899-3901. [PMID: 37045626 DOI: 10.1016/j.asjsur.2023.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Affiliation(s)
- Dong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Care Medicine, Jinan, China
| | - Changping Gu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Care Medicine, Jinan, China
| | - Meng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Care Medicine, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Care Medicine, Jinan, China; Department of Anesthesiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Cheeloo College of Medicine, Jinan, China.
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Shi C, Liu JZ, Zeng ZP, Miao Q, Fang LG, Chen S, Ping F, Sun H, Lu L, Chen LB, Fu Y, Zhao DC, Yu CH, JiaJue RZ, Wang X, Liu XR, Ma GT, Zhang CJ, Pan H, Yang HB, Wang YN, Li M, Li F, Shen ZJ, Liang ZY, Xing XP, Zhu WL. Diagnosis, Genetics, and Management of 24 Patients With Cardiac Paragangliomas: Experience From a Single Center. J Endocr Soc 2023; 7:bvad093. [PMID: 37873498 PMCID: PMC10590637 DOI: 10.1210/jendso/bvad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 10/25/2023] Open
Abstract
Context Paragangliomas located within the pericardium represent a rare yet challenging clinical situation. Objective The current analysis aimed to describe the clinical characteristics of cardiac paragangliomas, with emphasis on the diagnostic approach, genetic background, and multidisciplinary management. Methods Twenty-four patients diagnosed with cardiac paraganglioma (PGL) in Peking Union Medical College Hospital, Beijing, China, between 2003 and 2021 were identified. Clinical data was collected from medical record. Genetic screening and succinate dehydrogenase subunit B immunohistochemistry were performed in 22 patients. Results The median age at diagnosis was 38 years (range 11-51 years), 8 patients (33%) were females, and 4 (17%) had familial history. Hypertension and/or symptoms related to catecholamine secretion were present in 22 (92%) patients. Excess levels of catecholamines and/or metanephrines were detected in 22 (96%) of the 23 patients who have completed biochemical testing. Cardiac PGLs were localized with 131I-metaiodobenzylguanidine scintigraphy in 11/22 (50%), and 99mTc-hydrazinonicotinyl-tyr3-octreotide scintigraphy in 24/24 (100%) patients. Genetic testing identified germline SDHx mutations in 13/22 (59%) patients, while immunohistochemistry revealed succinate dehydrogenase (SDH) deficiency in tumors from 17/22 (77%) patients. All patients were managed by a multidisciplinary team through medical preparation, surgery, and follow-up. Twenty-three patients received surgical treatment and perioperative death occurred in 2 cases. Overall, 21 patients were alive at follow-up (median 7.0 years, range 0.6-18 years). Local recurrence or metastasis developed in 3 patients, all of whom had SDH-deficient tumors. Conclusion Cardiac PGLs can be diagnosed based on clinical manifestations, biochemical tests, and appropriate imaging studies. Genetic screening, multidisciplinary approach, and long-term follow-up are crucial in the management of this disease.
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Affiliation(s)
- Chuan Shi
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jian-Zhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zheng-Pei Zeng
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Li-Gang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Shi Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li-Bo Chen
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Da-Chun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Chun-Hua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Rui-Zhi JiaJue
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xi Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xing-Rong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Guo-Tao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Chao-Ji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong-Bo Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ming Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zhu-Jun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wen-Ling Zhu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Cutaia A, Gaetani C, Fonio P, Faletti R. Role of integrated imaging in the diagnosis of an atypical and unresectable cardiac paraganglioma: a case report. Eur Heart J Case Rep 2023; 7:ytad363. [PMID: 37554962 PMCID: PMC10406452 DOI: 10.1093/ehjcr/ytad363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Paragangliomas (PGLs) are rare neuroendocrine tumours that originate from extra-adrenal location. Cardiac PGLs can cause severe hypertension, palpitations, and lethal tachyarrhythmias. Diagnosis is based on measurement of plasma or urine metanephrines combined with conventional and nuclear imaging. Effective treatment is represented by surgical resection. We report a case of a 19-year-old patient with recurrent acute pericarditis; integrated imaging detected a large cardiac mass suggestive for PGL. CASE SUMMARY A 19-year-old male suffered pleuritic chest pain and fever for 4 days; electrocardiogram showed inferior ST elevation and transthoracic echocardiography a 2.2 cm pericardial effusion; these findings led to diagnose acute pericarditis. After a relapse of pericarditis, cardiac magnetic resonance and cardiac computed tomography (CCT) were performed, revealing a cardiac mass with radiological features of PGL. Blood and urine tests detected elevated levels of 3-methoxytyramine and chromogranin A. Gallium-68 positron emission tomography confirmed high metabolic activity of the mass. A negative 123-I-MIBG scintigraphy ruled out the possibility of radiometabolic treatment. A second CCT excluded the chance of surgical resection, due to intra-lesional course of the left anterior descending coronary artery. The young patient was referred to a different centre to achieve reduction of the mass, in order to potentially resect it afterwards. DISCUSSION Cardiac PGLs are rare tumours with significant morbidity related to norepinephrine secretion. In this case, without typical clinical manifestations and with no chance of surgical resection, integrated imaging played a central role in the differential diagnosis between PGL and other cardiac masses, providing both static and dynamic characterization.
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Affiliation(s)
- Aldo Cutaia
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
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Nazari MA, Jha A, Kuo MJM, Patel M, Prodanov T, Rosenblum JS, Talvacchio S, Derkyi A, Charles K, Pacak K. Paediatric phaeochromocytoma and paraganglioma: A clinical update. Clin Endocrinol (Oxf) 2023. [PMID: 37515400 DOI: 10.1111/cen.14955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Paediatric phaeochromocytomas and paragangliomas (PPGLs), though rare tumours, are associated with significant disability and death in the most vulnerable of patients early in their lives. However, unlike cryptogenic and insidious disease states, the clinical presentation of paediatric patients with PPGLs can be rather overt, allowing early diagnosis, granted that salient findings are recognized. Additionally, with prompt and effective intervention, prognosis is favourable if timely intervention is implemented. For this reason, this review focuses on four exemplary paediatric cases, succinctly emphasizing the now state-of-the-art concepts in paediatric PPGL management.
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Affiliation(s)
- Matthew A Nazari
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Abhishek Jha
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Mickey J M Kuo
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mayank Patel
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Tamara Prodanov
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Jared S Rosenblum
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Sara Talvacchio
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Alberta Derkyi
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Kailah Charles
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Karel Pacak
- Developmental Endocrinology, Metabolism, Genetics and Endocrine Oncology Affinity Group, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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11
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Punzo B, Baldi D, Ranieri B, Cavaliere C, Cademartiri F. Multimodality imaging of a cardiac paraganglioma: A case report. Front Cardiovasc Med 2023; 10:1123789. [PMID: 37034328 PMCID: PMC10080151 DOI: 10.3389/fcvm.2023.1123789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Cardiac paragangliomas (PGLs) are rare extra-adrenal tumors that arise from chromaffin cells of the sympathetic ganglia. PGLs are often diagnosed incidentally, in the absence of symptoms, or with symptoms related to cardiovascular dysfunction. Cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can be used to accurately determine the lesion morphology and position as well as providing detailed tissue characterization. A multimodal imaging approach, not yet standardized, could be useful either in diagnosis and monitoring or in treatment planning. In the case reported here, CCT and CMR were performed to define lesion anatomy, and a reconstruction was generated using cinematic rendering (CR) to characterize the PGL angioarchitecture.
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Affiliation(s)
- Bruna Punzo
- IRCCS SYNLAB SDN, Naples, Italy
- Correspondence: Bruna Punzo
| | | | | | | | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio/CNR, Pisa, Italy
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12
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Zhang J, Cao L, Yan L, Jin C, Zhang D. A young patient with heart failure was diagnosed with extra-adrenal paraganglioma: a case report. BMC Cardiovasc Disord 2022; 22:574. [PMID: 36581844 PMCID: PMC9801580 DOI: 10.1186/s12872-022-03026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We present a case of pelvic paraganglioma that presented with heart failure as the primary symptom. CASE PRESENTATION A 35-year-old man was admitted to hospital due to heart failure. Contrast-enhanced pelvic CT showed mass shadows in the posterior wall of the bladder and multiple enlarged lymph nodes in the retroperitoneal area. Ultrasound-guided puncture was performed, and the pathologic diagnosis was extra-adrenal paraganglioma. The patient refused any chemotherapy and died within six months of diagnosis. CONCLUSION The possibility of neuroendocrine-related tumors, for example paragangliomas, should be considered in young patients with heart failure, especially those with concomitant hypertension and diabetes.
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Affiliation(s)
- Jing Zhang
- grid.452828.10000 0004 7649 7439Respiratory Department, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, Liaoning China
| | - Lihua Cao
- grid.452828.10000 0004 7649 7439Respiratory Department, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, Liaoning China
| | - Lina Yan
- grid.452828.10000 0004 7649 7439Respiratory Department, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, Liaoning China
| | - Cong Jin
- grid.452828.10000 0004 7649 7439Respiratory Department, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, Liaoning China
| | - Dan Zhang
- grid.452828.10000 0004 7649 7439Respiratory Department, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, Liaoning China
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13
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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14
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A Rare Case of a Right Atrial Paraganglioma in an Individual with the SHDB Mutation. Case Rep Cardiol 2022; 2022:1140976. [PMID: 36226034 PMCID: PMC9550431 DOI: 10.1155/2022/1140976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/13/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Paragangliomas are extra-adrenal chromaffin cell tumors. A small percentage of these tumors can be found in the thoracic cavity and, when in the heart, are typically in the left atrium. In this case report, we discuss the case of an individual with a history of several paragangliomas with the SHDB mutation who was found to have two cardiac paragangliomas in the right atrium.
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15
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Wang X, Liu H, Zhang S, Huang S, Zhang C. The surgical strategy of hormonally active primary cardiac paraganglioma sarcoma: A case report. Front Cardiovasc Med 2022; 9:941142. [PMID: 36247467 PMCID: PMC9561550 DOI: 10.3389/fcvm.2022.941142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac paraganglioma is a kind of rare neuroendocrine tumor characterized by the persistent secretion of catecholamines. Under excessive exposure of catecholamines, some atypical symptoms are presented, including hypertension, arrhythmias, and headache. The case of surgical treatment of a 28-year-old woman with primary cardiac paraganglioma is presented for experience sharing and surgical skill improvements.
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16
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Dong X, Meng X, Zhang T, Zhao L, Liu F, Han X, Liu Y, Zhu H, Zhou X, Miao Q, Zhang S. Diagnosis and Outcome of Cardiac Paragangliomas: A Retrospective Observational Cohort Study in China. Front Cardiovasc Med 2022; 8:780382. [PMID: 35071353 PMCID: PMC8766960 DOI: 10.3389/fcvm.2021.780382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Cardiac paragangliomas (CPGLs) are rare neuroendocrine tumors that are easily overlooked and difficult to diagnose. Detailed comprehensive data regarding CPGL diagnosis and outcome are lacking. Methods: We retrospectively analyzed a cohort of 27 CPGL patients. This cohort represents the largest such cohort reported to date. Results: The prevalence of trilogy symptoms (concurrent palpitations, hyperhidrosis, and headache) was frequent (9/27, 33.3%). Sensitivity of echocardiography and contrast-enhanced computed tomography for localization of CPGL were 81.8% and 87%, respectively. Octreotide scintigraphy showed 100% sensitivity for detecting GPCLs, while sensitivity of I131-metaiodoben-zylguanidine scintigraphy was only 32.9%. Multiple tumors were found in 29.6% of patients. Most CPGLs originated from the epicardium or root of the great vessels (92.9%) and were mostly supplied by the coronary arteries and their branches (95.7%). Twenty-four patients underwent surgical treatment. Although local invasion was present in 40.0% of patients, it did not affect long-term outcome. Mean follow-up was 6.9 ± 3.6 years. Biochemical remission was achieved in 85% of patients. The recurrence rate was 15%. Conclusions: Manifestations of CPGLs are non-specific and they can be difficult to detect on imaging examinations. Octreotide scintigraphy should be performed in patients with suspected paragangliomas to screen for multiple lesions. Surgical resection of CPGLs can achieve symptom relief and biochemical remission.
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Affiliation(s)
- Xueqi Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Zhang
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Liu
- Department of Emergency, Puren Hospital of Beijing, Beijing, China
| | - Xu Han
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yecheng Liu
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yecheng Liu
| | - Huadong Zhu
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Huadong Zhu
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Xianliang Zhou
| | - Qi Miao
- Department of Cardiac Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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17
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Ma X, Chen Z, Xia P, Zhang C, Yan K, Fan Y, Wang Y, Ti Y, Bu P. Giant Paraganglioma Complicated With Catecholamine Crisis and Catecholamine Cardiomyopathy: A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2021; 12:790080. [PMID: 35185782 PMCID: PMC8851602 DOI: 10.3389/fendo.2021.790080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors which overproduce catecholamines. Heart failure and myocardial infarction caused by paraganglioma complicated with catecholamine crisis are the most common causes of death in PPGL patients before surgery. When giant paraganglioma is complicated with catecholamine crisis, treatment brooks no delay. CASE SUMMARY A 49-year-old man had episodic sweating, tachycardia with irregular pulse, and headaches 5 days before, and then showed up with chest pain and wheezing for 1 day. Meanwhile, he developed symptoms of recurrent severe abdominal pain and loss of consciousness, and his blood pressure was severely unstable (from 70/40 to 300/200 mmHg). First, the electrocardiogram showed ventricular tachycardia, and then we noticed the waves of ST-segment elevation, but we did not find significant abnormalities in coronary angiography. Abdominal CT and MRI revealed a giant lesion with bleeding or infection in the retroperitoneal adrenal area. These imaging findings were confirmed during surgery, and there was vascular adhesion between the retroperitoneal tumor and the inferior vena cava and left and right renal vein. After the successful resection of the tumor, postoperative pathology confirmed paraganglioma, and the patient pulled through and was discharged quickly. DISCUSSION This is a rare case of giant paraganglioma complicated with catecholamine crisis and catecholamine cardiomyopathy. We can diagnosis this disease greatly by elevated norepinephrine, and it is a gold biochemical standard at present. Standard treatment is surgical resection, which is effective in treating this rare neuroendocrine tumor.
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Affiliation(s)
- Xiangping Ma
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen Chen
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng Xia
- Department of Cardiology, Liaocheng People’s Hospital, Liaocheng Clinical School of Shandong First Medical University, Liaocheng, China
| | - Chunmei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Keqiang Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yidong Fan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yingli Wang
- Department of Cardiology, Liaocheng People’s Hospital, Liaocheng Clinical School of Shandong First Medical University, Liaocheng, China
| | - Yun Ti
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peili Bu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Peili Bu,
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18
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Otto CM. Heartbeat: weather, air pollution and cardiac arrest. Heart 2020; 106:1193-1195. [PMID: 32719148 DOI: 10.1136/heartjnl-2020-317777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98115, USA
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