대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Paraganglioma

Radiologic Findings

Figs 1 and 2. Chest PA and lateral radiographs reveal a large anterior mediastinal mass.
Fig 3. Enhanced chest CT demonstrates a hypervascular anterior mediastinal mass with necrotic changes and enlarged mediastinal lymph nodes.
Figs 4 and 5. MRI shows the mass with T2 high signal intensity, T1 intermediate signal intensity, multifocal necrotic changes, and diffusion restriction. Dynamic scans indicate continuous hyper enhancement.
Fig 6. PET-CT reveals increased FDG uptake in the mass and mediastinal lymph nodes.

Brief Review

Excision of intrathoracic mass revealed paraganglioma of the thorax with regional lymph node metastasis
Paragangliomas of the chest represent 1–2% of all paragangliomas. In the anterior mediastinum, they are usually parasympathetic paragangliomas, often presenting as aorticopulmonary lesions, and are typically asymptomatic, occurring in older patients over 40 years of age. In the posterior mediastinum, they are primarily sympathetic paragangliomas, commonly affecting younger patients with a mean age of 29 years. Approximately half of the cases in the posterior mediastinum are symptomatic.
Image features of paraganglioma shows hypervascular tumor characterized by multiple feeding vessels and a homogeneous capillary blush. It may exhibit hemorrhage or cystic degeneration and demonstrate high T2 signal intensity with early and progressive enhancement on imaging. Additionally, 123I-MIBG scanning is highly specific for their detection. Paragangliomas are not histologically classified as malignant or benign; instead, they are clinically considered malignant if metastasis is present. Approximately 2–13% of paragangliomas are reported to be malignant.

References

1. Hamidi O, Young WF Jr, Iñiguez-Ariza NM, Kittah NE, Gruber L, Bancos C, Tamhane S, Bancos I. Malignant Pheochromocytoma and Paraganglioma: 272 Patients Over 55 Years. J Clin Endocrinol Metab. 2017 Sep 1;102(9):3296-3305. doi: 10.1210/jc.2017-00992. PMID: 28605453; PMCID: PMC5587061.
2. Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, Kim KA, Lee NJ. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol. 2006 Aug;187(2):492-504. doi: 10.2214/AJR.05.0370. PMID: 16861555.
3. da Silva MCB, Shoji H, Franken M, Shiang C, Garcia RG, Engel FC, Gaiotto FA, Nunes LM, Funari MBG, Szarf G. Paraganglioma: An Uncommon Cause of Mediastinal Mass. Circ Cardiovasc Imaging. 2020 Feb;13(2):e009693. doi: 10.1161/CIRCIMAGING.119.009693. Epub 2020 Jan 31. PMID: 32000513.

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